On March 11, 2020, WHO declared COVID-19 a pandemic and it seemed everything changed. We had little understanding of what we were facing then. Three years on we’re still grappling with an ongoing pandemic and as AP (US) reports, “the virus is still spreading and the death toll is nearing 7 million worldwide. Yet most people have resumed their normal lives, thanks to a wall of immunity built from infections and vaccines. The virus appears here to stay, along with the threat of a more dangerous version sweeping the planet.” In analysis Health Policy Watch (Switzerland) notes, “The world’s choice to move on from the pandemic is reflected in the increasingly sparse data on case, test and death counts that once underpinned the breathless news cycle at the height of COVID-19’s assault…. Yet WHO has said it is not ready to declare an end to the pandemic, and some experts worry that the virus could mount a counter-attack. COVID-19’s continued circulation provides it with ample opportunities to mutate and become more transmissible by learning to sidestep immune responses.”
 
One of the lasting legacies of this pandemic is the inequity in the global response. The Guardian (UK) reports, “The Nobel laureate Joseph Stiglitz, former first lady of South Africa and Mozambique Graça Machel and former UN secretary general Ban Ki-moon are among nearly 200 signatories to a letter calling on governments to ‘never again’ allow ‘profiteering and nationalism’ to come before the needs of humanity, in the wake of the coronavirus pandemic…. ‘Profiteering’ of COVID-19 pandemic must never be repeated, world figures warn…. This inequity led to 1.3m preventable deaths worldwide – one every 24 seconds – in the first year of the COVID-19 vaccine rollout alone, according to analysis based on a study published in the Lancet. ‘That those lives were not saved is a scar on the world’s conscience,’ the letter continues.”

 

If You Are in a Hurry 

• Read more about the nexus of climate change and health in The Nation.
• Read a guest essay from Johns Hopkins’ Tom Inglesby on preparing for Disease X in The New York Times.
• Read Ars Technica on a clap back from the US CDC and FDA to the misinformation promoted by the Florida Surgeon General.
• Read The Atlantic on what being born into a world with COVID in place means for the next generation.
• Read The Washington Post on why we don’t remember much of the pandemic.

 

Climate Change and Health

 
The Nation (Kenya) reports, “Experts at the… Africa Health Agenda International Conference (AHAIC 2023) have predicted that malaria and cholera will prominently feature in diseases brought about by climate change. Speaking during the official opening of the conference in Kigali, Rwanda, Dr Ahmed Ogwell Ouma, the acting director of Africa CDC, said the effects of climate change are critical contributing factors to many of the health emergencies in the continent. ‘Disasters such as flooding, drought or other extreme weather patterns have contributed to poorer health outcomes due to disruptions in health services, thus reemergence of these diseases,’ he said.”
 

Preparing for Disease X

 
In a new series The New York Times (US) looks at preparation for the next pandemic, with a scaled down simulation of what should be done to prepare for ‘Disease X.” In an opening essay Johns Hopkins Tom Inglesby argues, “A concern is whether a new viral strain with higher case fatality [than COVID-19] will also develop the capacity for rapid spread among people. There is growing global concern over H5N1’s spread in animals — a development that governments must track and prepare for, and which all the more should broadly spur vigorous new pandemic preparedness efforts…. COVID-19 brought out incredible resolve, scientific ingenuity, individual and community perseverance and innovation. But even with that, millions of people died, many millions more were sickened, and societies were terribly set back in the United States and around the world. We are likely to face similar or worse pandemic threats in the future. We need to use the time we have now to make big preparedness changes to protect us from challenges that could arise again without warning.”
 

Growing Concern that Pandemic Preparedness is Slipping

 
Quartz (US) reports, “three years into a pandemic that killed almost 7 million people (and counting), and caused enormous economic and human damage, it seems the lessons haven’t been learned. One of the main global funds to support pandemic preparedness remains gravely underfunded. The World Bank’s pandemic fund—the only large fund exclusively dedicated to pandemic preparedness—was established with a goal of raising $10 billion, which the bank believes is enough to prevent the next pandemic from having such a deadly outcome…. As of February, the donors of the fund—which include rich nations, as well as organizations like the Gates Foundations or the Wellness Trust—have only pledged $1.6 billion.”
 

Politics and Misinformation

 
Ars Technica (US) reports on Florida surgeon general, Joseph Ladapo’s continued spread of misinformation. “Since his appointment as Florida's top doctor in late 2021, Ladapo has made false claims about vaccines, encouraged vaccine hesitancy, opposed masks, downplayed the health effects of COVID-19, and promoted ineffective COVID-19 treatments, such as ivermectin…. But Ladapo's efforts to thwart public health didn't stop at Florida's borders—the internal medicine doctor took his COVID-19 misinformation right to the Food and Drug Administration and the Centers for Disease Control and Prevention. And the agencies responded in kind. In a four-page letter dated March 10, FDA Commissioner Robert Califf and CDC Director Rochelle Walensky easily debunk his inaccuracies, falsehoods, and bluster, while taking the opportunity to point out that he is failing the people of Florida in his role as a public health official.”
 

Vaccine Manufacturing in Africa

 
The Washington Post (US) reports on the status of WHO-planned mRNA vaccine manufacturing hubs: “three years into the pandemic, the UN-backed program to build a network of self-reliant research and manufacturing sites is struggling. It is seeking a large increase in funds to ensure its sustainability, its backers say, raising concerns about the long-term future of the program. The United States has yet to respond to a funding request for $100 million, sent late last year by the effort’s backers. The support would about double its funding overall.”
 
Read a letter from advocacy groups to President Biden urging him to support the efforts. The letter argues, “Through this contribution, the United States can complement investments of other donors to support the establishment of the South African hub; support the 15 “spokes” to enable successful technology transfer; develop improved second-generation mRNA technology and a pipeline of novel vaccine candidates for SARS-CoV2 and other diseases relevant to low- and middle-income countries, including advancing at least one mRNA candidate vaccine to Phase 1/2a; and manufacturing for late-stage efficacy trials and vaccine introduction, pending trial results.”
 
The East African (Kenya) reports, “Health experts have advised that African governments would have to ensure that they own the intellectual property (IP) rights of vaccines and drugs manufactured in their countries if they are to accrue tangible gains from the drug making momentum building on the continent. Although, some African states have invested in research and development of vaccines and medicines, they have ended up relinquishing or selling IP rights to foreign firms, setting the vaccine manufacturing efforts back.”
 

Combatting Vaccine Hesitancy

 
The Nation (Kenya) reports that three years on only about four in ten Kenyans are vaccinated and most people have moved on from concern about the virus. Yet, “Prof Omu Anzala, in the Department of Medical Microbiology at the University of Nairobi, said that there is a need for serious dialogue with all healthcare professionals, communities, opinion leaders and policymakers on vaccine hesitancy and the danger in the population. ‘We need to tell people the importance of the vaccine and why they should be taking it,’ Dr Anzala said.”
 

Pandemic Lessons in Singapore

 
A commentary in Channel News Asia (Singapore) looks at a white paper on the Singapore pandemic response, noting that the concepts of “flexibility, agility, adaptability…. Featured heavily” in the analysis of the country’s response. Singapore’s decision to advance purchase mRNA vaccines “proved crucial: Singapore is now one of the highest vaccinated populations with low COVID-19 mortality rates. This strategic ability to recognize the high cost to the population if no action was taken and the likely high global demand for vaccines is an example of agility in unpredictable circumstances.”
 

What is the New COVID-19 Normal?

 
In an opinion piece in The Philadelphia Inquirer (US) biologist Maciej Boni invokes the history of vaccines in the US: Our country eliminated smallpox by the 1940s through mass vaccination campaigns. Polio was eliminated after vaccination was introduced in 1955. Expanded access to measles vaccines in the 1960s, 1970s, and 1980s led to the near-elimination of measles; last year, only 121 cases were reported in the entire country. However, the near-term outlook for COVID-19 vaccine coverage does not look nearly as good as it did for smallpox, polio, and measles.” Boni and colleagues estimate that unless we “manages to convince more people to get regular vaccinations, the US will settle into a permanent pattern of 90,000 to 120,000 COVID-19 deaths (or more) every year. That’s more than the deaths caused by all other infectious diseases combined.”
 

Why Are More Viruses Emerging?

 
Virologist Lindsay Broadbent writes in The Conversation (Australia) that as COVID-19 has faded from the news, “we’ve been regularly hearing about outbreaks of newly emerging or re-emerging viruses. So, is the incidence of virus outbreaks increasing? Or, have we just become better at detecting outbreaks thanks to improved technology developed during the COVID-19 pandemic? The answer may be a bit of both.” She notes that improved surveillance helps identify more outbreaks sooner, but “surveillance is only one part of pandemic preparedness. Governments and health and science agencies around the world need to have (regularly updated) virus emergence and pandemic protocols in place, so that we are not scrambling to understand a situation when it may already be too late.”
 

COVID-19’s Origins

 
Reuters (UK) reports, “Discovering the origins of COVID-19 is a moral imperative and all hypotheses must be explored, the head of the World Health Organization said, in the clearest indication yet that the U.N. body remains committed to finding how the virus arose.” Reuters notes, “the WHO has set up a scientific advisory group on dangerous pathogens but it has not yet reached any conclusions on how the pandemic began, saying key pieces of data are missing.”
 

Avian Flu Concerns in Europe

 
CIDRAP (US) reports, “In an updated assessment on H5N1 avian influenza, European health groups said though the risk to humans is still low, worrisome signs include the appearance of certain mutations in circulating strains and mass animal mortality events that hint at a greater risk of spread among mammals…. The groups said most recent H5N1 detections in mammals involve species such as red fox that hunt or scavenge infected birds or dead animals. However, they pointed to three mass mortality events: one involving harbor seals in Maine, an outbreak at a Spanish mink farm, and a die-off in Peruvian sea lions. Transmission events to and between mammals, serologic evidence of infection in wild boar and pigs, and mutations that would make the virus better adapted to mammals are concerning and need to be closely followed, they said.”
 

Preventing Pandemics with Reforestation

 
Pro Publica (US) looks at reforestation efforts and how they can help prevent pandemics. “Researchers have shown that deforestation can drive outbreaks by bringing people closer to wildlife, which can shed dangerous viruses. Scientists found these dynamics can explain several recent outbreaks of Ebola, including the largest one nearly a decade ago in Guinea…. The moment in which a virus jumps from an animal to a human is called spillover. Though we now know more than we ever have about why, where and how these events happen, global health authorities have failed to make preventing them a priority. Instead, they’ve focused resources on fighting outbreaks once they begin.” Pro Publica profiles a small nonprofit trying to prove that reforestation can be done by “providing affordable health care through mobile clinics and teaching residents how to grow more food and support themselves without cutting down more trees.”
 

COVID-19 and Inequities in the US

 
Bloomberg (US) reports, “Black children died of COVID-19 at almost three times the rate of White children, according to research that demonstrates the devastating impact racial disparities in the pandemic…. Black children were also more likely to lose a parent or caregiver because of COVID-19, and both Black and Latino households were more likely to face economic and health struggles. Read the study from the Morehouse School of Medicine.
 

When You Are Born Into COVID-19

 
The Atlantic (US) reports, “To be a newborn in the year 2023—and, almost certainly, every year that follows—means emerging into a world where the coronavirus is ubiquitous. Babies might not meet the virus in the first week or month of life, but soon enough, SARS-CoV-2 will find them…. Three years into the coronavirus pandemic, these babies are on the leading edge of a generational turnover that will define the rest of our relationship with SARS-CoV-2. They and their slightly older peers are slated to be the first humans who may still be alive when COVID-19 truly hits a new turning point: when almost everyone on Earth has acquired a degree of immunity to the virus as a very young child.”
 

Losing Our Pandemic Memories

 
The Washington Post (US) looks at how and why many of us are already forgetting the early, traumatic days of the pandemic. “COVID-19 disrupted everyone’s lives, but it was truly life-changing for only a sizable subset of people: those who lost someone to COVID-19, health-care workers, the immunocompromised or those who developed long covid, among others. For the rest of us, over time, many details will probably fade because of the quirks and limitations of how much our brains can remember…. The pandemic would seem unforgettable. It was a frightening, historic event, the likes of which most people have never encountered before. But so much has happened, it was difficult for our brains to encode the overload of information we had to sift through — masks, social distancing, super spreaders, more cases, more deaths, new waves and new variants such as omicron and delta, and who even remembers all the subvariants?”