H5N1

COVID-19 vaccines in high-risk ethnic groups

Via The Lancet: COVID-19 vaccines in high-risk ethnic groups.

Black, Asian, and minority ethnic communities worldwide have a disproportionate risk of severe COVID-19. In the UK, as of May 19, 2020, 36% of critically ill patients with COVID-19 requiring intensive care were from Black, Asian, or minority ethnic groups.1 According to Public Health England, the mortality risk from COVID-19, after accounting for sex, age, deprivation score, and geographical region, is double in Bangladeshi people and up to 50% higher in Black and south Asian people compared with White British people. This finding contrasts with age-adjusted all-cause mortality from previous years, which was lower in Asian and Black people than in White British people. These data imply that COVID-19 has more serious effects in Black and Asian people. 

The ethnic groups most affected by COVID-19 are under-represented in the COVID-19 vaccine trial data published so far. Despite efforts to encourage participation from Black, Asian, and minority ethnic groups, of the 552 participants in the phase 2/3 Oxford–AstraZeneca trial (based in Southampton and Oxford, UK), only one participant was Black and 19 were Asian. Large-scale trials also have a smaller proportion of minority groups compared with the populations sampled (appendix).

Black, Asian, and minority ethnic individuals are under-represented in research. However, the ongoing pandemic necessitates that access to trials and vaccinations shifts from being equal to being equitable. Study recruitment and participation designs should improve diversity in ethnic groups to maximise the validity of results to the populations concerned. Age and sex are routinely considered in recruitment design—the same should now apply to ethnicity. 

In the context of a pandemic that has higher infection and mortality risks in certain ethnic groups, it is important that these specific groups are adequately represented in vaccine trials to evaluate both immunogenicity and efficacy.

'Onions don't cure COVID-19': University of Guelph student combatting misinformation

Via CTV News: 'Onions Don't Cure COVID-19': University of Guelph student combatting COVID-19 misinformation.

GUELPH -- A University of Guelph student has created a website that helps debunk myths, conspiracies, and general misinformation around COVID-19…like how onions aren't the cure. 

The aptly named onionsdontcurecovid.com is part of a campaign started by Lauren Chang to help guide people through misconceptions about the virus. 

The site uses a series of infographics and videos to help share factual and credible information taken from Canadian Public Health surrounding COVID-19. 

"Our aim is not to look at these things and laugh at the people that may be believing it," said Chang. "This is why we encourage people to look at what the information is telling them to do, and as long as it doesn't hurt you and you're able to do it while following public health guidelines, I don't see a problem with it." 

She adds that, while everyone is able to benefit from the site, it's mostly geared towards immigrant communities. 

"Immigrant communities specifically have the problem of having linguistic barriers that deter them from accessing information from more traditional news sources or public health, which are usually only in English or French," said Chang. 

With the help from some other students, the information on the website is translated into 10 different languages. 

"It has specific reach to Chinese communities, Asian communities, and people from different cultural backgrounds and experiences," said Guelph student Pooja Sankar. "That's something that's really great about it." 

Chang says the site is constantly being updated as information about COVID-19 is constantly evolving. 

She is currently planning for her next campaign focused on vaccine education.

Covid-19 vaccine websites violate disability laws, create inequity for the blind

Via KHN, Lauren Weber and Hannah Recht write: Covid Vaccine Websites Violate Disability Laws, Create Inequity for the Blind. Excerpt:

Many covid vaccination registration and information websites at the federal, state and local levels violate disability rights laws, hindering the ability of blind people to sign up for a potentially lifesaving vaccine, a KHN investigation has found. 

Across the country, people who use special software to make the web accessible have been unable to sign up for the vaccines or obtain vital information about covid-19 because many government websites lack required accessibility features. At least 7.6 million people in the U.S. over age 16 have a visual disability. 

WebAIM, a nonprofit web accessibility organization, checked covid vaccine websites gathered by KHN from all 50 states and the District of Columbia. On Jan. 27, it found accessibility issues on nearly all of 94 webpages, which included general vaccine information, lists of vaccine providers and registration forms. 

In at least seven states, blind residents said they were unable to register for the vaccine through their state or local governments without help. Phone alternatives, when available, have been beset with their own issues, such as long hold times and not being available at all hours like websites. 

Even the federal Centers for Disease Control and Prevention’s Vaccine Administration Management System, which a small number of states and counties opted to use after its rocky rollout, has been inaccessible for blind users. 

Those problems violate the Rehabilitation Act of 1973, which established the right to communications in an accessible format, multiple legal experts and disability advocates said. The federal Americans with Disabilities Act, a civil rights law that prohibits governments and private businesses from discriminating based on disability, further enshrined this protection in 1990.

Deadly Donald Trump and 40 years of health failures

The Tyee has published my article: Deadly Donald Trump and 40 Years of Health Failures. Excerpt:

Four years ago, in the early weeks of Donald Trump’s presidency, I wrote an article describing him as an Ebola-level global health threat.

That was obviously a gross under-estimate. And Ebola was the wrong comparison. The outbreak that began in 2013 in West Africa, the worst in history, took about 11,000 lives. (Another outbreak has just started in Guinea, but now it can be fought with experienced health care workers and vaccine.) 

Compared to the lives Trump is responsible for shortening or ending, Ebola was a rounding error. In a recent article, science writer Laurie Garrett charged him with pandemicide. But COVID-19 is only one factor in the deaths caused by Trump and a 40-year attack on American public health. 

Soon after I wrote my 2017 article, The Lancet, a major British medical journal, established one of its commissions. Unlike its other commissions that look at the impact of this or that disease, this one was to focus on the impact of Trump and his policies. 

That commission has now published “Public policy and health in the Trump era,” an indictment not only of Trump but of the 40 years of neoliberal policies begun by Ronald Reagan. It may take another 40 years to repair the damage.

US life expectancy drops a year in pandemic, most since WWII

Via The Associated Press: US life expectancy drops a year in pandemic, most since WWII. Excerpt:

Life expectancy in the United States dropped a staggering one year during the first half of 2020 as the coronavirus pandemic caused its first wave of deaths, health officials are reporting. 

Minorities suffered the biggest impact, with Black Americans losing nearly three years and Hispanics, nearly two years, according to preliminary estimates Thursday from the Centers for Disease Control and Prevention. 

“This is a huge decline,” said Robert Anderson, who oversees the numbers for the CDC. “You have to go back to World War II, the 1940s, to find a decline like this.” 

Other health experts say it shows the profound impact of COVID-19, not just on deaths directly due to infection but also from heart disease, cancer and other conditions. 

“What is really quite striking in these numbers is that they only reflect the first half of the year ... I would expect that these numbers would only get worse,” said Dr. Kirsten Bibbins-Domingo, a health equity researcher and dean at the University of California, San Francisco. 

This is the first time the CDC has reported on life expectancy from early, partial records; more death certificates from that period may yet come in. It’s already known that 2020 was the deadliest year in U.S. history, with deaths topping 3 million for the first time. 

Life expectancy is how long a baby born today can expect to live, on average. In the first half of last year, that was 77.8 years for Americans overall, down one year from 78.8 in 2019. For males it was 75.1 years and for females, 80.5 years. 

As a group, Hispanics in the U.S. have had the most longevity and still do. Black people now lag white people by six years in life expectancy, reversing a trend that had been bringing their numbers closer since 1993. 

Between 2019 and the first half of 2020, life expectancy decreased 2.7 years for Black people, to 72. It dropped 1.9 years for Hispanics, to 79.9, and 0.8 years for white people, to 78. The preliminary report did not analyze trends for Asian or Native Americans. 

“Black and Hispanic communities throughout the United States have borne the brunt of this pandemic,” Bibbins-Domingo said. 

They’re more likely to be in frontline, low-wage jobs and living in crowded environments where it’s easier for the virus to spread, and “there are stark, pre-existing health disparities in other conditions” that raise their risk of dying of COVID-19, she said.

Priorities for the COVID-19 pandemic at the start of 2021: Statement of the Lancet COVID-19 Commission

Via The Lancet: Priorities for the COVID-19 pandemic at the start of 2021: statement of the Lancet COVID-19 Commission. Excerpt:

The Lancet COVID-19 Commission calls for three urgent actions in the COVID-19 response (our broader overview is available on our website). 

First, all regions with high rates of new COVID-19 cases, including the USA and the European Union (EU), should intensify measures to minimise community transmission alongside rapid deployment of COVID-19 vaccines. 

Second, governments should urgently and fully fund WHO and the Access to COVID-19 Tools (ACT) Accelerator, including COVAX. 

Third, the G20 countries should empower the International Monetary Fund (IMF) and multilateral development banks to increase the scale of financing and debt relief. 

Success on all three priorities—containment of transmission, rapid vaccination, and emergency finance—will require improved global cooperation. The high rates of community transmission (>100 new COVID-19 cases per million per day) in the USA, Europe, South Africa, and other countries show the emergence of new variants of SARS-CoV-2, such as lineage B.1.1.7 in the UK, 501Y.V2 in South Africa, and additional variants emerging in California, USA, and in Brazil. 

New lineages are increasing transmission of infection and raising risks in regions that have been less affected by COVID-19, including in sub-Saharan Africa. Additionally, acquired immunity from earlier COVID-19 infections might be less protective against reinfection with some of the new SARS-CoV-2 variants. Mutant lineages might also reduce the efficacy of COVID-19 vaccines and require adapted vaccines or boosters. 

The numbers of new COVID-19 cases in east Asia and the Pacific (<10 new cases per million per day in most countries) have been consistently below those of Northern America and Europe. The lower numbers of COVID-19 cases in these countries result from the successful implementation of comprehensive containment measures: border restrictions and other limits on movement; behavioural changes including widespread use of face masks and physical distancing; active surveillance by public health systems, including mass testing, backward tracing (to identify the sources of outbreaks), and forward tracing (to identify the contacts of new cases); and the quarantine of all suspected cases and the use of facility-based isolation of confirmed cases of COVID-19. 

The USA and the EU failed to implement such comprehensive measures, and there was generally excessive decentralisation of containment efforts across the 50 US states and 27 EU members in 2020. Lack of centralised coordination undermined control of COVID-19, not least because of interstate travel in the USA and intercountry travel in the EU. Both the USA and EU need to step up more top–down coordination in 2021. 

Stronger health systems that incorporate universal health coverage and community-based health workers are vital in the response to COVID-19. At least half of the world's population lacks access to essential health services. Strengthening community-based and gender-responsive health systems will be essential to implement inclusive and comprehensive COVID-19 immunisation campaigns. 

The global roll-out of COVID-19 vaccines to date is neither inclusive nor adequately planned. COVAX has targeted immunisation coverage of at least 20% of the population in each participating country by the end of 2021, and has contracted for 2 billion doses of COVID-19 vaccines. Yet the timely supply of vaccines to COVAX is in question, as high-income countries (HICs) step to the front of the queue for limited supplies of COVID-19 vaccines. 

As of Feb 9, 2021, 148·08 million COVID-19 vaccine doses had been delivered, of which 115·67 million were delivered in the USA (43·21 million), China (40·52 million), the EU (18·36 million), and the UK (13·58). Other countries in Africa, Latin America and the Caribbean, and Asia (not including China) have received very few vaccine doses or none at all. 

This unequal access to COVID-19 vaccines is partly due to the difficulty of managing the ultracold supply chain needed for the two mRNA vaccines, but it is also due to the vaccine supply deals negotiated by HICs directly with the vaccine producers, rather than through COVAX.

US could have averted 40% of Covid-19 deaths, says panel examining Trump's policies

The new Lancet commission is already making waves. Via The Guardian: US could have averted 40% of Covid deaths, says panel examining Trump's policies. Excerpt:

The US could have averted 40% of the deaths from Covid-19, had the country’s death rates corresponded with the rates in other high-income G7 countries, according to a Lancet commission tasked with assessing Donald Trump’s health policy record. 

Almost 470,000 Americans have died from the coronavirus so far, with the number widely expected to go above half a million in the next few weeks. At the same time some 27 million people in the US have been infected. Both figures are by far the highest in the world. 

In seeking to respond to the pandemic, Trump has been widely condemned for not taking the pandemic seriously enough soon enough, spreading conspiracy theories, not encouraging mask wearing and undermining scientists and others seeking to combat the virus’ spread.

Dr Mary T Bassett, a commission member and director of Harvard University’s FXB Center for Health and Human Rights, told the Guardian: “The US has fared so badly with this pandemic, but the bungling can’t be attributed only to Mr Trump, it also has to do with these societal failures … That’s not going to be solved by a vaccine.” 

In a wide-ranging assessment published on Thursday, the commission said Trump “brought misfortune to the USA and the planet” during his four years in office. The stinging critique not only blamed Trump, but also tied his actions to the historical conditions which made his presidency possible. 

“He was sort of a crowning achievement of a certain period but he’s not the only architect,” said Bassett, “And so we decided it’s important to put him in context, not to minimize how destructive his policy agenda has been and his personal fanning the flames of white supremacy, but to put it in context.” 

The commission condemned Trump’s response to Covid, but emphasized that the country entered the pandemic with a degraded public health infrastructure. Between 2002 and 2019, US public health spending fell from 3.21% to 2.45% – approximately half the share of spending in Canada and the UK. 

To determine how many deaths from Covid the US could have avoided, the commission weighted the average death rate in the other G7 countries – Canada, France, Germany, Italy, Japan and the UK – and compared it to the US death rate. 

In another comparison, the commission found if US life expectancy was equivalent to the average in the other G7 countries, 461,000 fewer Americans would have died in 2018. 

The Lancet commission on public policy and health in the Trump era, launched in April 2017 to catalogue Trump health policies, examines the driving forces of his 2016 election win and offers policy recommendations. The 33 commissioners are from the US, UK and Canada and work in public health, law schools, medicine, unions, indigenous communities and other groups. 

The commission devotes as much time in the report to its namesake as it does to the conditions that made him possible. 

A line is drawn from neoliberal policies pushed in the past 40 years, such as those that intensified the drug war and resulted in mass incarceration, to health inequities Trump exacerbated while in office. Many of the connections date back even further, to the colonization of the Americas and the persistence of white supremacy in society.

US health and health care are a mess: Now what?

Via The Lancet: US health and health care are a mess: now what? Excerpt:

The report of the Lancet Commission on Public Policy and Health in the Trump Era is a tour de force as a chronicle of the failings of both the health-care system in the USA and the society and public institutions that create and perpetuate those failings. This Commission's report is likely to serve as a reference document on these matters for years to come. In surfacing the ideological and systemic causes of US health-care problems, this Commission confronts the challenge of correcting them. In that respect, its analysis still leaves deep uncertainty about a path forward. 

The Commission's critique of US health care is broad, deep, and innovative. It provides a thorough review of the presidency and administration of Donald Trump and the many destructive executive orders he signed, which have led to, among other things, loss of health coverage for millions of US residents. The report could serve as a starting point for the corrective actions and policies of the new administration of President Joseph Biden and Vice President Kamala Harris. 

The Commissioners comprehensively document the inadequate support of the US public health apparatus, including the fateful decrease in public health funding between 2002 and 2019 from 3·21% to 2·45% of national health spending and the resulting loss of about 50 000 public health positions nationally, just when they were most needed to confront COVID-19. 

Also compelling is the Commission's framing of reduced life expectancy in the USA compared with other high-income nations. In 2018, the Commission states that 461 000 US residents “went missing” as a result of the nation's reduced longevity. This silent epidemic of shortened lives suggests that hundreds of thousands of avoidable deaths could be added to the close to 500 000 deaths that COVID-19 will have claimed in the USA by the middle of February, 2021. 

The Commission also links shortcomings in US health care to the country's history of racism, economic inequality, and social policy choices that have failed to create a minimally secure safety net for the US population. The Commission correctly points out that changes in public policy related to housing, food and income security, education, and systemic racism will be necessary for the country to overcome its health-care deficits.

The Guardian: Our key findings about US healthcare worker deaths to date

Via The Guardian: Our key findings about US healthcare worker deaths to date. Excerpt:

As of 10 February, Lost on the frontline has counted more than 3,400 healthcare worker deaths. The pandemic is not over, and this project is therefore a work in progress, with new names added weekly. 

These are our findings to date. 

More than half were younger than 60 

In the general population, the median age of death from Covid-19 is 78. Yet among health care workers in our database, it is only 59. The majority of people who died were under the age of 60. Hundreds of even younger people also died while working on the frontlines.

Two in three deceased health care workers identified as people of color 

Although white Americans account for about 76% of the US population, we found that almost as many black health care workers died as white health care workers.

Many of the cases involved concerns over inadequate PPE 

We learned that a large number of those who died were worried about not having enough personal protective equipment (PPE). (We only possess information about PPE concerns for a smaller subset of cases, based on interviews with family members, friends and colleagues, as well as text messages or online messages some victims sent before they died.) 

More than a third of the health care workers who died were born outside the United States 

And those from the Philippines accounted for a disproportionate number of deaths.

Nurses and support staff account for most deaths 

Roughly one in three were nurses, but the total also includes physicians, pharmacists, first responders and hospital technicians, among others.

Ensure Palestinians have access to COVID-19 vaccines

A letter in The Lancet: Ensure Palestinians have access to COVID-19 vaccines.

The health predicament in the occupied Palestinian territory has been inexcusable, and the COVID-19 pandemic is exacerbating problems. As of Feb 8, 2021, WHO reports that more than 183 000 Palestinians have tested positive for severe acute respiratory syndrome coronavirus 2, and more than 2000 people have died from COVID-19. According to the UN, “Israel has not ensured that Palestinians under occupation in the West Bank and Gaza will have any near-future access to the available vaccines”. This statement is despite WHO's roadmap for COVID-19 vaccine prioritisation stating that people in particular settings (eg, refugee and detention camps, prisons) should be prioritised for vaccination. 

We recognise that Palestinians have the right to life, health, and dignity. Differential access to necessary health care is ethically and legally unacceptable and, under the terms of The Geneva Conventions, Israel has a responsibility for those living under its occupation; the 1995 Israeli–Palestinian Interim Agreement cannot be used as a justification for Israeli inaction. 

We call on media organisations to report on the serious health burden and increasing number of lives at risk as COVID-19 spreads among the Palestinian people. Media organisations have a moral responsibility to report on this situation without discrimination and with moral courage. 

We support agencies, such as WHO and Amnesty International, in their efforts to demand that Israel ensure swift and equitable access to vaccines and increase the health-care system's capacity in the occupied Palestinian territory. However, theseorganisations do not have the executive power to force states to respect rights. Israel needs to fulfil its international obligations by providing full financial support to ensure that any programmes meet minimum standards. 

We call on multilateral development banks to support the expansion of Palestinian public health-care infrastructure and capacity to allow Palestinians a dignified life that any person deserves, as per the Universal Declaration of Human Rights. 

We call on manufacturers developing these crucial vaccines to ensure access for all Palestinian people under occupation, including those living in refugee and detention camps, which could involve donations of storage units and equipment. 

Finally, we call on individuals and civil society organisations to raise global awareness of the situation in the occupied Palestinian territory and ask Israel to honour its commitment to medical ethics and human rights by ensuring access to COVID-19 vaccines for Palestinians living under occupation. 

Israel has a moral obligation to ensure that Palestinians have access to COVID-19 vaccines available under emergency use mechanisms or compassionate use and to support such a vaccination programme. Anything short of that is a breach of medical and professional ethics and a clear act of discrimination.