H5N1

Mpox in the DR Congo: A dozen patients fleeing clashes between army and M23

Via 7sur7.cd, a major news outlet in Kinshasa: Mpox: A dozen sick people fleeing in South Kivu. The Google translation:

Residents of South Kivu are expressing concern following the escape of a dozen Mpox patients from the Miti-Murehesa treatment centre. They fled the clashes between the FARDC and the M23.  

According to the report of the Ministry of Health, there are 17 Mpox patients, including 10 confirmed positive and 7 awaiting results interned in the Miti-Murhesa health zone.  

Contacted on this subject, Professor Manwa Baudoin, a specialist in medical biology, said that these people who have not been declared cured of Mpox will create a hotbed of activation of the disease, thus creating a high risk of contamination.  

He calls on all sections of the population to mobilize and apply the classically known barrier measures, including avoiding any contact with a sick or dead animal, its meat or its blood as well as contact with a person infected with MPOX.  

However, Birindwa Ariship, medical director of the Mpox treatment center of the UOB university clinics in the city of Bukavu, the security situation is hampering the supply of medical supplies, a huge need for the treatment of pathologies.  

The security situation in South Kivu province has deteriorated since February 14, 2025, with the entry of M23/AFC rebels. The Kamituga health zone is the epicenter of the pathology in the region.

WHO: Protecting key populations from abrupt disruptions to essential HIV services

A statement from WHO on the destruction of US foreign health programs: Protecting key populations from abrupt disruptions to essential HIV services.

Prevention, testing and treatment services for HIV, viral hepatitis and sexually transmitted infections (STI) have driven unprecedented progress in improving population health over the past two decades, with millions of new HIV infections and AIDS-related deaths averted.  

Foreign aid investments in the global HIV response, such as the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund on AIDS, TB and Malaria, have been pivotal to this success, also contributing significantly to progress towards elimination of hepatitis B and C, and STI control. However, abrupt disruptions to foreign aid and service delivery threaten these gains, putting millions of people at risk – especially people living with HIV and key and vulnerable populations.  

Many essential evidence-based prevention interventions, including HIV pre-exposure prophylaxis (PrEP), harm reduction services for people who inject drugs, and community-led programmes have been permanently halted.  

Early reports shared with WHO indicate that prevention and treatment services for key populations are those most affected. Reports include the closure of health centres delivering prevention, testing and treatment interventions for key populations previously supported by U.S. funding.  

These disruptions are resulting in staffing shortages, supply chain interruptions, and increased barriers to access, leaving key populations – including gay men and other men who have sex with men, sex workers, people who inject drugs, people in prisons, and trans and gender diverse individuals – vulnerable to infection and death, as well as increased stigma and discrimination.  

These developments compromise the ability of service providers to deliver on foundational WHO recommendations that:   

• all people living with HIV should receive same-day antiretroviral treatment (ART) both to improve their health and to prevent further transmission by achieving sustained viral load suppression;   

• there should be uninterrupted access to ART for all populations, including key populations living with HIV, during service disruptions; and   

• person-centred approaches should be implemented and non-judgemental, discrimination-free environments created to foster trust, encourage consistent engagement in care, and support re-engagement for those who may have dropped out of treatment.  

Essential prevention services must remain a priority  

Ensuring that key populations can access prevention services that are free of discrimination is central to HIV, hepatitis and STI responses. Community-based services have consistently proven effective in increasing access and acceptability of programmes, buffering the effects of stigma and discrimination. These programmes facilitate the delivery of interventions that have been proven effective through rigorous scientific research, and that are recommended by WHO to protect people from new infections and harm.  

Core WHO-recommended essential prevention services include condoms and lubricants; testing for HIV, hepatitis B and C, and other STIs; HIV post-exposure prophylaxis and pre-exposure prophylaxis; and harm reduction activities including distribution of needles and syringes, of naloxone to prevent deaths from overdose, and opioid agonist maintenance treatment programmes.  

Commitment to sustainable financing and integrated health systems  

As countries and ministries of health work to mitigate the impact of service disruptions, they must pursue long-term solutions, including sustainable domestic financing to protect these vital health services. This is essential for maintaining the downward trend in HIV incidence and mortality, and to progress toward hepatitis elimination and STI control.   

WHO also emphasizes the value of an integrated approach to HIV, bringing together stigma and discrimination-free services for tuberculosis, viral hepatitis, sexual and reproductive health, and noncommunicable diseases under the umbrella of strong primary health care. Integrating HIV leads to resource optimization and improvements in overall population health.   

WHO remains committed to supporting national governments, partners, and donors in adapting to shifting donor support to safeguard the health and well-being of those most vulnerable to HIV, viral hepatitis and STIs.

WHO statement on potential global threat to people living with HIV

From the World Health Organization: WHO statement on potential global threat to people living with HIV. The entire statement:

The World Health Organization (WHO) expresses deep concern about the implications of the immediate funding pause for HIV programmes in low- and middle-income countries. These programmes provide access to life-saving HIV therapy to more than 30 million people worldwide. Globally, 39.9 million people were living with HIV at the end of 2023.  

A funding halt for HIV programmes can put people living with HIV at immediate increased risk of illness and death and undermine efforts to prevent transmission in communities and countries. Such measures, if prolonged, could lead to rises in new infections and deaths, reversing decades of progress and potentially taking the world back to the 1980s and 1990s when millions died of HIV every year globally, including many in the United States of America.  

For the global community, this could result in significant setbacks to progress in partnerships and investments in scientific advances that have been the cornerstone of good public health programming, including innovative diagnostics, affordable medicines, and community delivery models of HIV care.  

We call on the United States Government to enable additional exemptions to ensure the delivery of lifesaving HIV treatment and care.  

PEPFAR’s legacy and current risks  

The United States President's Emergency Plan for AIDS Relief (PEPFAR) has been a flagship initiative of the global HIV response since its establishment over 20 years ago. The current funding pause for PEPFAR will have a direct impact on millions of lives that depend on the predictable supply of safe and effective antiretroviral treatment.  

PEPFAR works in over 50 countries around the world. Over the past two decades, PEPFAR funding has saved more than 26 million lives. Currently, PEPFAR is providing HIV treatment for more than 20 million people living with HIV globally, including 566 000 children under 15 years of age.  

Over the past year, PEPFAR and partners, including WHO, have been working on sustainability plans with countries for greater country ownership and reduced donor support up to and beyond 2030. A sudden and prolonged stop to programmes does not allow for a managed transition and puts the lives of millions at risk.  

WHO is committed to support PEPFAR and other partners, as well as national governments, in managing change processes effectively to minimize the impact on people living with HIV.

Traumatic injury mortality in the Gaza Strip from Oct 7, 2023, to June 30, 2024: a capture–recapture analysis

Via The Lancet: Traumatic injury mortality in the Gaza Strip from Oct 7, 2023, to June 30, 2024: a capture–recapture analysis. The summary:

Background  

Accurate mortality estimates help quantify and memorialise the impact of war. We used multiple data sources to estimate deaths due to traumatic injury in the Gaza Strip between Oct 7, 2023, and June 30, 2024.  

Methods  

We used a three-list capture–recapture analysis using data from Palestinian Ministry of Health (MoH) hospital lists, an MoH online survey, and social media obituaries. After imputing missing values, we fitted alternative generalised linear models to the three lists' overlap structure, with each model representing different possible dependencies among lists and including covariates predictive of the probability of being listed; we averaged the models to estimate the true number of deaths in the analysis period (Oct 7, 2023, to June 30, 2024). Resulting annualised age-specific and sex-specific mortality rates were compared with mortality in 2022.  

Findings  

We estimated 64 260 deaths (95% CI 55 298–78 525) due to traumatic injury during the study period, suggesting the Palestinian MoH under-reported mortality by 41%. The annualised crude death rate was 39·3 per 1000 people (95% CI 35·7–49·4), representing a rate ratio of 14·0 (95% CI 12·8–17·6) compared with all-cause mortality in 2022, even when ignoring non-injury excess mortality. Women, children (aged <18 years), and older people (aged ≥65 years) accounted for 16 699 (59·1%) of the 28 257 deaths for which age and sex data were available.  

Interpretation  

Our findings show an exceptionally high mortality rate in the Gaza Strip during the period studied. These results underscore the urgent need for interventions to prevent further loss of life and illuminate important patterns in the conduct of the war.

See also this report in The Guardian.

Bird flu, measles top 2025 concerns for Canada's chief public health officer

Via The Canadian Press: Bird flu, measles top 2025 concerns for Canada's chief public health officer. Excerpt:

TORONTO - As we enter 2025, Dr. Theresa Tam has her eye on H5N1 bird flu, an emerging virus that had its first human case in Canada this year.  

At the same time, Canada's chief public health officer is closely monitoring measles — a virus that was eliminated in this country more than two decades ago, but is making an accelerated resurgence.  

H5N1, a strain of highly pathogenic avian influenza viruses carried by wild birds, has been on the rise globally. It has decimated poultry farms in Canada and infected dairy cattle herds in several states south of the border.  

But its spread to humans is especially worrisome.  

"What I am particularly concerned about is that this virus has demonstrated the capability of a whole range of clinical outcomes, from asymptomatic infection ... all the way to rare cases of severe illness," said Tam in a year-end interview on Dec. 18.  

"So it's something that we really need to be very vigilant about.”  

Canada's only confirmed H5N1 patient — a teen in B.C. — was severely ill and hospitalized in November. Health officials there have still not been able to determine how the teen got infected.  

No one else got sick with the virus, said Tam, which is encouraging because it suggests there hasn't yet been any human-to-human transmission.  

Although the risk to the general public is still considered low, there have been at least 65 confirmed human cases in the U.S. in 2024, mostly among farm workers. Most cases have been mild, with conjunctivitis, or pink-eye, among the symptoms.  

But on the same day as The Canadian Press interview with Tam, health officials announced the first case of severe illness in the U.S. — a person over 65 in Louisiana who had been in contact with sick birds in a backyard flock.  

”(That) tells me that we need to do significant outreach not just to commercial poultry farms, for instance, but there are people who keep backyard chickens or other birds," Tam said.  

"Those backyard birds are exposed to wild birds that are the carriers of this H5N1 virus."  

Education about wearing personal protective equipment and taking biosecurity measures is important for anyone keeping birds in Canada — not just commercial farms, she said.  

Tam says it's also time for more bird flu awareness among the general public.  

“We need to handle any sick or dead birds (or) other animals with a great deal of care," she said.  

"If in doubt, don't touch and call up your local veterinarian or public health authority in order to know what to do if you do have dead birds or animals in your garden or backyard.”  

But it's not just new illnesses that Tam is worried about. "There's an increase in circulation of a number of vaccine-preventable diseases like measles, like pertussis (whooping cough)," she said.  

Tam said there have been close to 170 measles cases in Canada in 2024, compared to 59 cases last year.

Increases in US life expectancy forecasted to stall by 2050, poorer health expected to cause nation’s global ranking to drop

Via the Institute for Health Metrics and Evaluation, an alarming news release: Increases in U.S. life expectancy forecasted to stall by 2050, poorer health expected to cause nation’s global ranking to drop. Excerpt:

SEATTLE, Wash., Dec. 5, 2024 – The U.S. is failing to keep pace with dozens of countries around the world due to the steady decline of the nation’s health progress, according to a detailed analysis of all 50 states and Washington, D.C., published in The Lancet. Researchers at the Institute for Health Metrics and Evaluation (IHME) produced health estimates and forecasts (the most likely future) of life expectancy, mortality, and morbidity due to more than 350 diseases and injuries and 68 risks in the U.S. from 1990 to 2050.  

U.S. life expectancy improvements slow, global ranking drops     

Life expectancy (LE) in the U.S. is forecasted to increase from 78.3 years in 2022 to 79.9 years in 2035 and to 80.4 years in 2050 for all sexes combined. This modest increase lowers the country’s global ranking from 49th in 2022 to 66th in 2050 among the 204 countries and territories included in the latest Global Burden of Disease (GBD) study.   

Nationally, mortality rates declined between 1990 and 2021 for many leading causes of death, most notably for ischemic heart disease, cancer, and stroke. That contributed to improvements in life expectancy. Despite the progress the U.S. has made over the last three decades, the country is forecasted to rank progressively lower than other nations globally in the average number of years a person can expect to live in good health. Known as healthy life expectancy or health-adjusted life expectancy (HALE), its global ranking is forecasted to drop from 80th in 2022 to 108th by 2050.    

Women’s health in the U.S. is falling behind other peer countries faster than men’s. Female HALE is forecasted to decline by 2050 in 20 states, including Ohio, Tennessee, and Indiana. Only three states remain unchanged: Arizona, Idaho, and North Dakota. This gap between men and women is mainly due to the slow increases or no changes in female life expectancy and HALE rather than due to major improvements for males. 

Canada needs a national COVID-19 inquiry now

Via BMC Medicine: Canada needs a national COVID-19 inquiry now . The abstract:

Background  

We are now in the fifth year of an ongoing pandemic, and Canada continues to experience significant surges of COVID-19 infections. In addition to the acute impacts of deaths and hospitalizations, there is growing awareness of an accumulation of organ damage and disability which is building a “health debt” that will affect Canadians for decades to come. Calls in 2023 for an inquiry into the handling of the COVID-19 pandemic went unheeded, despite relevant precedent. Canada urgently needs a comprehensive review of its successes and failures to chart a better response in the near- and long-term.  

Main body  

While Canada fared better than many comparators in the early years of the COVID-19 pandemic, it is clearly still in a public health crisis. Infections are not only affecting Canadians’ daily lives but also eroding healthcare capacity. Post-COVID condition is having accumulating and profound individual, social, and economic consequences.  

An inquiry is needed to understand the current evidence underlying policy choices, identify a better course of action on various fronts, and build resilience. More must be done to reduce transmission, including a serious public education campaign to better inform Canadians about COVID and effective mitigations, especially the benefits of respirator masks. We need a national standard for indoor air quality to make indoor public spaces safer, particularly schools. Data collection must be more robust, especially to understand and mitigate the disproportionate impacts on under-served communities and high-risk populations.  

General confidence in public health must be rebuilt, with a focus on communication and transparency. In particular, the wide variation in provincial policies has sown mistrust: evidence-based policy should be consistent. Finally, Canada’s early success in vaccination has collapsed, and this development needs a careful post-mortem.  

Conclusions  

A complete investigation of Canada’s response to the pandemic is not yet possible because that response is still ongoing and, while we have learned much, there remain areas of dispute and uncertainty. However, an inquiry is needed to conduct a rapid assessment of the current evidence and policies and provide recommendations on how to improve in 2025 and beyond as well as guidance for future pandemics.

Political polarization and health

A very timely report via Nature Medicine: Political polarization and health. The abstract:

In addition to social determinants of health, such as economic resources, education, access to care and various environmental factors, there is growing evidence that political polarization poses a substantial risk to individual and collective well-being. 

Here we review the impact of political polarization on public health. We describe the different forms of polarization and how they are connected to health outcomes, highlighting the COVID-19 pandemic as a case study of the health risks of polarization. 

We then offer strategies for mitigating potential harms associated with polarization, with an emphasis on building social trust. Finally, we propose future research directions on this topic, underscore the need for more work in a global context and encourage greater collaboration between social scientists and medical scientists. 

We conclude that polarization is a serious—if largely overlooked—determinant of health, whose impacts must be more thoroughly understood and mitigated.

Financialisation: a 21st century commercial determinant of health equity

Via The Lancet Public Health: Financialisation: a 21st century commercial determinant of health equity. The summary:

In 21st century capitalism, financial markets reign supreme. The elevation of investing, trading, and speculating as a way of making profit has shifted economic power towards institutional investors and enhanced the power of financial capital.  

Financialisation has introduced uncertainty in the commitment to public provision of goods and services. The behaviours of corporations focus more on profit for shareholders and senior executives to the detriment of wages, worker protections, livelihoods, and impact on prices and the environment. The practices of this financial system pose major challenges to public health and planetary health equity through the influence on social inequality, climate change, and health outcomes.  

The aim of this Viewpoint is to expand the understanding of the commercial determinants of health to explicitly include the financial system and present key plausible pathways via which the financialisation of advanced economies influences public health and planetary health equity. The global public health community must pay close attention to these key commercial determinants of health.  

It is now crucial to reduce the power of financial actors and hold financial actors accountable. Civil society groups can highlight their practices, articulate alternative visions, and hold financial actors and governments to account. Interdisciplinary research must provide a diagnosis of the financial and public health issues, and, importantly, illuminate effective pathways forward. Financial and commercial worlds must return to stakeholder primacy rather than that of the shareholder.

Excess Death Rates by State During the COVID-19 Pandemic: United States, 2020‒2023

Via AJPH: Excess Death Rates by State During the COVID-19 Pandemic: United States, 2020‒2023. The full article is paywalled, but the abstract confirms some earlier studies:

Objectives. To estimate state-level excess death rates during 2020 to 2023 and examine differences by region and partisan orientation.  

Methods. We modeled death and population counts from the Centers for Disease Control and Prevention to estimate excess death rates for the United States, 9 census divisions, and 50 states. We compared excess death rates for states with different partisan orientations, measured by the party of the seated governor and the level of partisan representation in state legislatures.  

Results. The United States experienced 1 277 697 excess deaths between March 2020 and July 2023. Almost 90% of these deaths were attributed to COVID-19, and 51.5% occurred after vaccines were available. The highest excess death rates first occurred in the Northeast and then shifted to the South and Mountain states. Between weeks ending June 20, 2020, through March 19, 2022, excess death rates were higher in states with Republican governors and greater Republican representation in state legislatures.  

Conclusions. Excess death rates during the COVID-19 pandemic varied considerably across the US states and were associated with partisan representation in state government, although the influence of confounding variables cannot be excluded.