AVAC's weekly Pandemic Watch is a curated news digest on the latest pandemic prevention, preparedness, and response (PPPR) news and resources.

"The mandate for this so-called Pandemic Treaty is necessarily wide-ranging and ambitious, covering intersecting issues such as antibiotic resistance, universal health coverage, intellectual property laws on medicines, cooperation on disease surveillance, and not least importantly, the human-environment interactions that contribute to pandemic risk. The Pandemic Treaty therefore represents an important opportunity to take an integrated whole-environment approach to strengthening global health.”

-- Editorial in The Lancet Planetary Health ([link removed](23)00030-X/fulltext?rss=yes)


** Table of Contents
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* Pandemic Preparedness
* Pandemic Funding
* This Week in Bird Flu
* Mpox Vaccines Inequity in the US
* Long COVID
* COVID-19 Origins
* COVID Inequities
* Dengue in Bolivia and Sudan
* Shigella in the US
* Financing mRNA Vaccines
* Cholera in Malawi

This week at the Africa Health Agenda International Conference 2023 in Kigali, Rwanda delegates are discussing the intersection of climate change and health and what the continent and the world need to do to in response. Health Times ([link removed]) (Zimbabwe) reports, “During the first plenary, the Rwanda health minister emphasized the need to support countries to reinforce their health systems to adapt, be more resilient and better cope with climate-linked emergencies. ‘Speed matters in controlling disease outbreaks together with the four key elements that are paramount: health, science, leadership, community and communication. We as humans disrupt this harmony. The sooner we stop an outbreak to become a pandemic, the better.’ He said some of the measures that need to be taken include assessing health system weaknesses, developing and implementing measures to cushion people’s lives and health from the adverse consequences of climate-related health crises.”

Dr. Sam Oti tweeted ([link removed]) a quote from Wellcome Trust’s Dr Modi Mwatsama in a plenary: "The climate crisis is a whole-of-society crisis and requires researchers working in an integrated manner across different sectors to find solutions.”

Much of the conference conversations have focused on the outsize impact of climate change and health issues on women and young people and the need for them to be part of crafting solutions. Sara Jerving tweeted a very direct quote from Dr. Ebere Okereke, incoming CEO of Africa Public Health Foundation: "The era of old grey-haired men is over. We need to bring in women and young people to be part of the future of global health that we want to see.”



** If You're in a Hurry
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Listen to the latest episode of the Px Pulse podcast ([link removed]) to hear Chris Collins on what’s at stake for pandemic preparedness.

Then read editorials in The Lancet Planetary Health ([link removed](23)00030-X/fulltext?rss=yes) and BMJ ([link removed]) about the promise of the Pandemic Treaty now being negotiated.

Read Devex ([link removed]) on a new Africa Epidemics Fund.

Read Scientific American ([link removed]) on potential vaccine development for bird flu.

Read Telegraph ([link removed]) on a dengue outbreak in Bolivia that is overwhelming hospitals.

Read a BMJ ([link removed]) editorial on what’s wrong with mRNA COVID vaccine pricing.



** Pandemic Preparedness
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An editorial in The Lancet Planetary Health ([link removed](23)00030-X/fulltext?rss=yes) (UK) looks at the Pandemic Treaty being negotiated now by WHO and countries. “The mandate for this so-called Pandemic Treaty is necessarily wide-ranging and ambitious, covering intersecting issues such as antibiotic resistance, universal health coverage, intellectual property laws on medicines, cooperation on disease surveillance, and not least importantly, the human-environment interactions that contribute to pandemic risk. The Pandemic Treaty therefore represents an important opportunity to take an integrated whole-environment approach to strengthening global health.”

A BMJ ([link removed]) (UK) editorial argues the Pandemic Treaty, “is a once-in-a-generation opportunity. It is a chance to take a leap forward in addressing the systemic inequities in access to health products and technologies that hampered the covid-19 response and which led to fractured and often insufficient responses to stop the spread and devastation. It will also address the underlying inequities within and across WHO member states, including capacities to prevent, prepare, and respond to public health emergencies, epidemics, and pandemics, as well as improving health system recovery, research, and development of pandemic related products, health and care workforce and financing, and universal health coverage. This is all with an aim to safeguard people living in vulnerable situations who were disproportionately affected by the pandemic.”

In the latest episode of AVAC’s Px Pulse podcast ([link removed]) , Jeanne Baron talks to Chris Collins about what’s at stake as health leaders and advocates create new architecture for pandemic preparedness, which policy-makers get it already, why this year matters so much, and what advocates can do about it.


** Pandemic Funding
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Devex ([link removed]) (US) reports, “South African President Cyril Ramaphosa will lead fundraising for the Africa Epidemics Fund — a new pool of finance to assist countries in preparation and response to disease threats on the continent…. The initiative is a part of a series of efforts the AU has taken to lessen its dependence on entities abroad during health emergencies and falls in line with Africa CDC’s New Public Health Order. Continental ownership over this fund is critical. Devex recently reported that Africa CDC has applied to become an implementing entity of the World Bank’s Pandemic Fund, saying its exclusion from this role ‘considerably constrained’ its ability to ‘play its AU-mandated role as convenor and coordinator of health security in Africa.’”

Reuters ([link removed]) (UK) reports, “More than 100 low- and middle-income countries have put in early bids for at least $5.5 billion from a fund that initially has only $300 million to spend to help them better prepare for pandemics. The demand is a sign that pandemic prevention, preparedness and response needs more money and attention, the head of the fund’s secretariat at the World Bank, Priya Basu, told Reuters.


** This Week in Bird Flu
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Scientific American ([link removed]) (US) reports, “Avian flu is not new; epidemiologists have been studying it for decades. But the detection of the virus in mammals has many concerned about the potential that it could spill over to humans and cause a larger outbreak.” Most experts say a human outbreak is not a high risk at the moment. “Yet even a virus that causes mild or moderate illness in many people can have a serious toll, as we’ve seen with the COVID pandemic. So efforts are underway to develop vaccines to protect against such a form of bird flu.”

New York Times ([link removed]) (US) reports, “The Biden administration, keeping a watchful eye on an outbreak of avian influenza that has led to the deaths of tens of millions of chickens and is driving up the cost of eggs — not to mention raising the frightening specter of a human pandemic — is contemplating a mass vaccination campaign for poultry, according to White House officials….Experts at the Centers for Disease Control and Prevention, whose focus is human health, say the risk of a pandemic is low. As a precaution, the agency has sent drug manufacturers flu virus samples that could form the basis of vaccines for people. The C.D.C. is also exploring whether commercial test manufacturers would be willing to develop tests for H5N1, similar to those used for the coronavirus.”

Nature ([link removed]) (UK) notes, “If bird flu does trigger a human pandemic, there are a number of tools for combating the disease. Approved human vaccines against avian flu exist, and the World Health Organization monitors the evolution of H5N1 so that these vaccines can be updated appropriately. In the United States, the Biomedical Advanced Research and Development Authority has a stockpile of vaccines, although the supply is too low to be used to vaccinate the world. Animal studies and observational data in humans suggest the antiviral drug Tamiflu is effective against H5N1 in people, although there have been reports of resistant strains. Non-pharmaceutical tools including face masks can also limit disease spread.”


** Mpox Vaccine Inequity in the US
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The Hill ([link removed]) (US) reports, “A disproportionately low number of Black individuals received the mpox vaccine during the public health emergency for the virus, which lasted for several months before ending earlier this year. The Human Rights Campaign (HRC) released a report on Wednesday that found Black people made up one-third of all new mpox cases from May ([link removed]) , when the first cases of the outbreak were found, until the end of January, when the public health emergency ended. But they only made up one-tenth of all vaccine recipients for the virus during that time.”



** Long COVID
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The Guardian ([link removed]) (UK) reports a “vacuum of information remains as much of the US has moved on from the pandemic, while Covid long-haulers continue to face stigma and questions over whether their symptoms are real, providers say. But while there has only been a trickle of new information about long Covid, doctors say that they remain confident that researchers will find answers to fundamental questions about the disease, such as: aside from contracting the virus itself, what actually causes long Covid?”

CIDRAP ([link removed]) (US) reports, “Two new observational studies suggest that COVID-19 vaccination lowers long-COVID incidence and severity, although the authors of a related commentary say trials comparing vaccination with a placebo are needed. The research was published yesterday in BMJ Medicine ([link removed]) ... The authors conclude, ‘We found that covid-19 vaccination reduced the severity of symptoms and the effect of long covid on patients' social, professional, and family lives in those who already have persistent symptoms of infection.’”

Bloomberg ([link removed]) (US) via Business Live reports on researchers’ efforts to understand long COVID through examining virus particles in wastewater. One researcher is quoted: “’You can find lots of chronic infections — people that are probably infected for over a year — where the virus hasn’t changed at all. And I don’t understand why in some patients it just goes crazy.’… As the Covid-19 scourge enters a fourth year, patients such as the one Johnson uncovered by tracing back through kilometers of waste pipes and drains are nudging researchers closer to answers for key questions: where do worrisome new mutants come from?, and what’s their role in long Covid, the mysterious post-infection ailment that afflicts 140-million people globally?”

BMJ ([link removed]) (UK) reports, “Black and Hispanic Americans are more likely than white Americans to have symptoms of long covid and some people who had covid early in the epidemic may have long covid but not be diagnosed as such because of coding changes, show studies funded by the National Institutes of Health…. Mitchell Elkind, professor of neurology and epidemiology at Columbia University Medical Center in New York and chief clinical officer of the American Heart Association, said, ‘New evidence suggests that there may be important differences in how long covid manifests in different racial and ethnic groups. Further research is needed to understand better the mechanisms for these differences in symptoms and access to care, and also if diagnostic codes assigned by clinicians may play a role.’”


** COVID-19 Origins
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Bloomberg ([link removed]) (US) reports, “The World Health Organization said all hypotheses for the origin of the Covid-19 pandemic are still on the table, after US authorities this week backed the theory that the virus originated from a lab.” Tedros is quoted: “The continued politicization of the origins research has turned what should be a purely scientific process into a geopolitical football. [This] only makes the task of identifying the origins more difficult.”

AP ([link removed]) (US) reports, “COVID-19′s origins remain hazy ([link removed]) . Three years after the start of the pandemic, it’s still unclear whether the coronavirus that causes the disease leaked from a lab or spread to humans from an animal. This much is known: When it comes to COVID-19 misinformation, any new report on the virus’ origin quickly triggers a relapse and a return of misleading claims about the virus, vaccines and masks that have reverberated since the pandemic began ([link removed]) ...


** COVID Inequities
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Public Health Post ([link removed]) (US) reports, “The COVID-19 vaccine’s release a year into the pandemic provided hope to the world as the new and deadly virus traversed the globe. Health agencies had the primary goal of providing quick and accurate vaccine information. However, millions of people could not understand the vaccine reports on their local government’s website and faced multiple barriers to being protected against the virus... Compared to people who speak English, people with limited English proficiency (LEP) were more likely to contract and die from COVID-19 and less likely to receive the vaccine when it was rolled out. Lack of accurate and available translations intensified the pandemic’s harm on people with limited English proficiency. Many depended on English-speaking friends and family, social media, and international news for COVID-19 communication. The pandemic also magnified the existing shortage of
professional linguists and pushed many health care institutions to use automated translations like Google Translate.”



** Dengue in Bolivia and Sudan
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The Telegraph ([link removed]) (UK) reports, “Bolivia’s Ministry of Health has reported more than 11,000 cases of [dengue], while 33 people have died, mostly children. Multiple regions, including Santa Cruz and La Paz, are now under a red epidemiological alert…. Global warming, which creates more temperate conditions in which [the mosquitos that carry dengue] can thrive, is also a major factor in this worldwide rise; so too is the post-pandemic travel boom, which has seen a spike in mosquito-borne diseases crossing borders... Vaccines are seen by most as the only way of turning the tide on dengue, which the World Health Organization last year said could spark the next pandemic ([link removed]) .”

Sudan Tribune ([link removed]) reports, “Sudan on Wednesday declared a fever epidemic in Khartoum state, after confirming 533 cases of [dengue], with another 928 suspected cases being monitored. Cases of mosquito-borne illness occur every year in Darfur, Kordofan regions and some areas of central Sudan due to the fragile health system in the country. On February 15, 2023, the minister of health for the first time announced the existence of dengue fever in Khartoum state and announced that 169 suspected cases had been recorded, including 110 confirmed cases.”


** Shigella in the US “Serious Public Health Threat”
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NBC News ([link removed]) (US) reports, “The Centers for Disease Control and Prevention is warning about a rise in extensively drug-resistant cases of the bacterial infection Shigella, a major cause of inflammatory diarrhea. The agency calls the new form of the stomach bug, which causes the diarrheal condition known as shigellosis, a ‘serious public health threat.’ Evidence suggests the illness is spreading among gay and bisexual men in particular, apparently through sexual contact, both in the US and abroad.



** Financing mRNA Vaccines
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A BMJ ([link removed]) (UK) editorial argues, “In making health and protection possible amid a deadly pandemic, the mRNA covid-19 vaccines have been a remarkable achievement. However, their development also serves as a cautionary tale of a system in which the risks of pursuing innovation were socialized, while the lion’s share of rewards became privatized to corporate shareholders—financial actors who risked little of their capital in the development process... Traditional policy thinking narrowly conceives of the public role in biomedical research as “fixing market failures” by financing basic science.9 Yet the covid-19 mRNA vaccines show that public risk taking and investment were essential in shaping all stages of technology development, production, and procurement. The US government failed to take on one other important role, however: directing the very value it played an indispensable role in creating. An alternate innovation strategy would instead include
three features: directionality, conditionality, and public options.”



** Cholera in Malawi
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Devex ([link removed]) (US) reports, “Malawi is experiencing the deadliest cholera outbreak in its history. The outbreak which has lasted for nearly one year has spread to all 29 districts in the country with a consistently high case fatality rate of above 3 percent. Experts have attributed the prolonged outbreak to a cocktail of factors which include structural problems in the water, sanitation, and hygiene sector, lack of access to accurate information on the disease, and climatic factors including flooding, which affects access to clean water in communities.”
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