We’re in the fourth year of the COVID-19 pandemic with no clear indication of when it might be over – or at least – more contained. Even as we grapple with this ongoing pandemic, the wise among us know that we need to be prepared for the next one and the one after that. Even as we look to the lessons that can be learned from the global COVID-19 response, it’s important to look at other pandemic responses to understand how best to prepare for the future. A group of global advocates and researchers write in PLOS Global Public Health (US) that “the infrastructure and core principles of the HIV response have much to contribute towards strengthening [pandemic preparedness and response (PPR)]…. HIV elicited a response that was arguably unique in the annals of global health – prioritizing human rights and gender equality, welcoming the leadership of communities and people living with HIV, drawing on principles of global solidarity and shared responsibility to mobilize unprecedented financial resources, building on inclusive health governance, and aiming for universal access to the fruits of scientific research.” The authors conclude, “The world urgently needs to prepare for the next pandemic. With new resources that are strategically channeled, it is possible to accelerate progress against HIV while strengthening pandemic preparedness in a manner that advances global health equity and security.”
 

If You Are in a Hurry

 

• Read a Special Communication in JAMA Network Open that argues for replicating the fast-track development of COVID-19 vaccines for other research needs.
• Read a call from a Ugandan health official to develop a plan for Ebola vaccination in Nature.
• Read Nature and Politico on looking for the next COVID variant.
• Read CDC’s Emerging Infectious Diseases on Mpox circulation before the recent outbreak.
• Read a BMJ opinion on the need for a global cholera plan.
• Read Medscape and Contagion Live on COVID and risks for pregnant women.
• Read Devex on climate change and health in East Africa.

 

Time to End the Global Emergency?

 
STAT (US) reports, “On Friday, an emergency committee will meet again to deliberate whether the time has come to recommend to WHO Director-General Tedros Adhanom Ghebreyesus that he declare the global health emergency is over. The final decision rests with Tedros, who generally — though not always — follows the advice of WHO emergency committees…. On Tuesday Tedros hinted he doesn’t feel the time is right, noting that Covid deaths are on the rise again globally. Over the past eight weeks, more than 170,000 such deaths have been reported, he said, adding that figure is certainly an underestimate.”
 

Building on Lessons Learned from COVID-19 Vaccine Trials

 
The authors of a Special Communication in JAMA Network Open (US) argue, “Within weeks of the start of the crisis, the US government leveraged industry, government, and academic resources toward the study of COVID-19 vaccines and monoclonal antibodies in diverse populations worldwide. This effort leveraged the expertise of existing research networks, established a joint DSMB, deployed 5 phase 3 clinical trials with harmonized end points, and ultimately led to the successful completion of multiple studies and FDA-authorized vaccines in less than a year….This cross-platform approach led to harmonization of data collection across trials and the ability to analyze data from all studies, a novel approach that will continue to yield answers to pressing questions and help guide public health policy. Importantly, this success can be replicated for other important research initiatives and serve as a standard for future clinical studies. Investment and use of this collaborative cross-platform model will continue to provide answers to pressing COVID-19 questions and serve as a model for future pandemics.”
 

An Ebola Vaccination Strategy

 
Henry Kyobe Bosa, national incident manager for Ebola and COVID-19 for Uganda writes in a Nature (UK) opinion piece that the recent success in ending the Ebola outbreak in Uganda took a toll. “But the quarantines and lockdowns came at a high cost, especially for the country’s poorest people. We need a better way. The world did not rely solely on lockdowns, quarantines and contact tracing to fight COVID-19. When rich countries are affected by a fatal infectious disease, there is a massive global effort to develop vaccines and therapeutics.” He argues, “Preventive, not reactive, vaccination is needed to fight Ebola” and calls in wealthy countries to help develop a plan.
 
The Independent (Uganda) interviewed Uganda’s Dr Allan Muruta, the commissioner in charge of Epidemiology Surveillance and Public Health Emergencies at the Ministry of Health on what’s needed to prepare for the next epidemic. Reflecting on the recent Ebola outbreak, Muruta says, “One of the things we learnt is that effective coordination is very important. We harnessed the resources from the partners much more effectively to respond. We brought the partners together, planned together and then asked them what and which were they going to support.”
 

COVID-19 in China

 
Reuters (UK) reports, “The possibility of a big COVID-19 rebound in China over the next two or three months is remote as 80 percent of people have been infected, a prominent government scientist said on Saturday. The mass movement of people during the ongoing Lunar New Year holiday period may spread the pandemic, boosting infections in some areas, but a second COVID-19 wave is unlikely in the near term, Wu Zunyou, chief epidemiologist at the China Center for Disease Control and Prevention.”
 
Bloomberg via Seattle Times (US) reports, “Chinese are turning to social media influencers and celebrities for tips about treating COVID-19, after the country’s whipsaw reversal in virus strategy undermined trust in government advice and health officials…. China’s rapid dismantling of pandemic restrictions over a matter of weeks at the end of last year led to a quick surge in infections, with COVID-19 spreading through cities and towns that have had little experience with the virus until now. With the government hastily retreating, people are increasingly looking to social media for answers, resulting in a corresponding increase in misinformation and even dangerous advice.”
 

Looking for the Next Variant

 
Nature (UK) reports, “Fears that the massive surge of coronavirus infections in China could immediately spark the emergence of a troubling new variant are unfounded, say researchers. But that could change in the coming months as more people in the country acquire some natural immunity from infection. More widespread immunity could drive the virus SARS-CoV-2 to evolve ways to evade this immune protection. It remains crucial that variants be tracked, yet scientists question how quickly the next variant of concern will be detected as many countries wind down surveillance efforts.”
 
Politico (US) reports, “As COVID-19 cases explode in China and new viral threats loom, the Biden administration is ramping up surveillance of biological samples from international passengers arriving at US airports to scan for new virus variants and other hazards to Americans’ health.” This includes voluntary nasal swabs at some airports and “the Centers for Disease Control and Prevention is pursuing talks with airlines and port authorities to start collecting samples from long-haul international flights’ wastewater after they land.”
 

COVID-19 in North Korea?

 
France 24 (France) reports, “North Korea has ordered a five-day lockdown in the capital over "respiratory illness", a report said Wednesday, in what appears to be the first citywide restrictions since the country declared victory over COVID-19 in August 2022…. Experts suggested that North Korea's largest city is likely dealing with the re-emergence of Covid…. North Korea has one of the world's worst healthcare systems, with poorly equipped hospitals, few intensive care units and no Covid treatment drugs, experts say. It is not believed to have vaccinated any of its 25 million people, although reports indicate it may have received some vaccines from China.”
 

Bird Flu and Minks

 
Science (US) reports on an outbreak of a deadly avian influenza virus, H5N1 in a Spanish mink farm, raising new concerns that the virus could spread to other mammals, including humans. “How readily the virus found in Spain might infect humans—or spread between them—is unknown. Sequenced virus samples from four mink show several changes compared with the bird virus, including T271A, a mutation in the gene for an enzyme, polymerase. The change, also seen in viral samples from other infected mammals, is known to help H5N1 better replicate in mammalian tissues.”
 

Paxlovid for Long COVID?

 
The Body (US) reports on. US NIH-funded study that “aims to enroll 1,700 participants at sites nationwide this year to determine whether a 15-day course of Paxlovid―which is three times longer than the usual course taken for acute COVID-19―can mitigate or clear long COVID symptoms.” The Body also highlights the work of the Network for Long COVID Justice in pushing for the study and other research, quoting HIV researcher Steven Deeks. “Deeks points out that existing research on long COVID was sparked from the same source as the research that eventually led to HIV breakthroughs: ‘a powerful group of community advocates pushing for change—including longtime HIV activists like JD Davids who understand how this game is played. That’s why we currently have the funding for long COVID that we do.’”
 

Risks for Long COVID

 
CIDRAP (US) reports, “A US military study suggests that people who are unvaccinated against COVID-19 and those with moderate or severe infections are at significantly higher risk for persistent symptoms for 1 to 6 months…. Unvaccinated participants who received at least one vaccine dose 1 to 12 months after infection were at an estimated 41 percent lower risk of still having symptoms at 6 months (RR, 0.59), and greater disease severity was associated with ongoing symptoms.” Read the study in JAMA Open Network.
 

Cholera Plan Needed

 
 A BMJ (UK) opinion argues, “Once thought to be close to eradication, cholera is back—dehydrating and killing people within hours and ravaging communities across six continents. Despite the alarming numbers of cases and deaths over the past year, decision makers are averting their eyes, leaving people to die from a preventable and treatable disease. The healthcare community should sound the alarm for immediate actions. A strong and global emergency response is urgently needed, but it is only a first step. More than ever the world must invest in water and sanitation systems and prepare communities before outbreaks occur.”
 
Al Jazeera (Qatar) reports, “Malawi’s worst cholera outbreak on record has left more than 1,000 people dead even as cases have reached 30,621, health minister Khumbize Chiponda has said. The death toll announced on Tuesday breached a grim milestone and surpassed the largest recorded outbreak…. In September, the WHO warned that after years of decline, there was a “worrying upsurge” in cholera outbreaks globally, with climate change adding to traditional triggers such as poverty and conflict. The disease affects between 1.3 million and four million people worldwide each year, causing up to 143,000 deaths.”
 
Josephine Chinele reports in GAVI’s Vaccines Work Blog about a Malawian woman who was recently vaccinated along with her children for cholera following an outbreak in her area. “An earlier volley of vaccines rolled out in May – but Mwanga, like many others, was only moved to seek immunisation when the disease arrived at her doorstep. ‘I heard about the vaccination campaign in May last year but I honestly took this disease lightly. I have been particularly moved by the deaths of the people I know. Some of them were hesitant to get vaccinated,’ Mwanga told me.”
 

COVID-19 and Pregnancy

 
Medscape (US) reports on a meta-analysis of previous research published in BMJ Global Health: “Women infected with COVID-19 during pregnancy are seven times more likely to die during childbirth or during the pregnancy than uninfected pregnant women, a new study shows. The new report also warns of many other severe complications linked with the virus during pregnancy, as well as risks to the baby after birth. But the researchers said they did not find that COVID-19 infection during pregnancy impacted the risk of stillbirth or a baby's growth rate during pregnancy.” Read the meta-analysis here.
 
Contagion Live (US) reports, “COVID-19 during the first 6 months of pregnancy, with the Omicron variant specifically, was found to increase the risk of maternal morbidity and severe complications among symptomatic, unvaccinated women, according to a paper published in The Lancet…. In looking at the impact of vaccination, the study authors observed that unvaccinated women with COVID-19 diagnosis had a greater risk of MMMI. Additionally, severe cases of COVID-19 symptoms in unvaccinated women increased the risk of severe maternal complications, perinatal complications, and referral, ICU admission, or death, the study authors found.” Read the study in The Lancet.
 

Annual COVID-19 Vaccines?

 
STAT (US) reports, “Scientists at the Food and Drug Administration propose making COVID-19 vaccination a regular, once-a-year shot that is updated to match current strains of the SARS-CoV-2 virus, according to documents posted by the FDA on Monday. For people who are older or immunocompromised, the FDA would recommend two annual doses of the revised shot.” NPR (US) reports, “Vaccine makers would update the annual shot through a process that would begin each spring to try a match the vaccine as closely as possible to whatever variant will likely be dominant in the coming winter. That's how the flu vaccine is formulated each year.”
 

The Future of COVID-19 Vaccines

 
CNET (US) asks, “What if you could drink your COVID-19 vaccine instead of rolling up your sleeve? No needle -- just a "swish and swallow," and your new immunity is down the hatch.  You might be able to within the next couple of years, as researchers expand their focus onto mucosal vaccines, which include nasal or inhaled vaccines as well as "swish and swallow" oral vaccines…Scientists hope mucosal vaccines will not only protect against severe disease and death, like the revolutionary mRNA vaccines and boosters have proven to do time and time again, but ward off infections as well. However, they'll need a body of evidence behind them, which requires attention and money.” None of the vaccines highlighted in the CNET article are near efficacy studies or approvals.
 

Mpox Silently Circulating for 20 Years

 
A Research letter in US CDC’s Emerging Infectious Diseases notes, “our analyses of MPXV genome sequences indicate that the virus has been circulating silently and undetected for about 2 decades, probably in multiple non–MPXV-endemic countries outside of Africa. Also, a clear genomic signature of a recent change in hosts is evidenced by major changes in its nucleotide substitution pattern. Our observations have major public health implications; the changing epidemiology of MPXV infections and human circulation of the virus in non–MPXV-endemic countries call for increased surveillance. The public health crisis caused by the COVID-19 pandemic may have favored the spread of MPXV under the radar in the past few years; however, the existence of asymptomatic carriers cannot be ruled out and may have contributed to the undetected spread of MPXV.”
 

Climate Change and Health

 
In a Devex (US) opinion piece Kenyan scientist Melvine Otieno writes, “People across [East Africa] are unarguably witnessing extreme pressures from the consequences of climate change on human health — and the situation is straining the precarious state of public health systems. National governments, the international community, public health practitioners and planners, policymakers, research scientists, and other relevant stakeholders must recognize and understand the seriousness of how climate change will affect the health of the public — and act.