H5N1

WHO launches global network to detect and prevent infectious disease threats

A WHO news release: WHO launches global network to detect and prevent infectious disease threats. Excerpt:

WHO and partners are launching a global network to help protect people from infectious disease threats through the power of pathogen genomics. The International Pathogen Surveillance Network (IPSN) will provide a platform to connect countries and regions, improving systems for collecting and analyzing samples, using these data to drive public health decision-making, and sharing that information more broadly.  

Pathogen genomics analyzes the genetic code of viruses, bacteria and other disease-causing organisms to understand how infectious they are, how deadly they are, and how they spread. With this information, scientists and public health officials can identify and track diseases to prevent and respond to outbreaks as part of a broader disease surveillance system, and to develop treatments and vaccines.  

The IPSN, with a Secretariat hosted by the WHO Hub for Pandemic and Epidemic Intelligence, brings together experts worldwide at the cutting-edge of genomics and data analytics, from governments, philanthropic foundations, multilateral organizations, civil society, academia and the private sector. All share a common goal: to detect and respond to disease threats before they become epidemics and pandemics, and to optimize routine disease surveillance.  

The goal of this new network is ambitious, but it can also play a vital role in health security: to give every country access to pathogen genomic sequencing and analytics as part of its public health system,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus.  “As was so clearly demonstrated to us during the COVID-19 pandemic, the world is stronger when it stands together to fight shared health threats.”  

COVID-19 highlighted the critical role pathogen genomics plays in responding to pandemic threats. Without the rapid sequencing of the SARS-COV-2 genome, vaccines would not have been as effective, or have been made available so quickly. New, more transmissible variants of the virus would not have been as quickly identified.  

Genomics lies at the heart of effective epidemic and pandemic preparedness and response, as well as part of the ongoing surveillance of a vast range of diseases, from foodborne diseases and influenza to tuberculosis and HIV. Its use in monitoring the spread of HIV drug resistance, for example, has led to antiretroviral regimes that have saved countless lives.

Bird flu could become the next human pandemic – and politicians aren’t paying attention

Via The Guardian, an op-ed: Bird flu could become the next human pandemic – and politicians aren’t paying attention. Excerpt:

Since November, the signals emerging across the world continue to be worrying. In January and February this year, more than 3,000 sea lions died of bird flu in Peru (where the death toll in wild birds reached an estimated 50,000). In Russia, 700 Caspian seals died. Then several dolphins in Britain and the US died of H5N1. Normally, even if an animal catches H5N1 from a bird, it can’t pass it to other mammals. This limits its spread. But the large number of cases in these outbreaks suggest the possibility of mammal-to-mammal transmission, although this hasn’t been confirmed yet by genetic sequencing. A more likely hypothesis is that these outbreaks are groups of animals feeding on infected birds. It is not yet 100% clear what’s happening.  

But the risk of spread among mammals is ever-present. A new research pre-print from Canada showed that H5N1 samples could spread efficiently between ferrets with fatal outcomes. In order to spread efficiently to humans, H5 would need three major categories of genetic changes, according to bird flu expert Prof Richard Webby. So far, the virus has been able to make one of these changes, but not the other two. 

So right now, H5N1 is a theoretical risk for the next human pandemic, rather than one requiring urgency in response today. And a prime minister or health secretary might say, “Why prepare for something that might never happen?” 

To those of us scientists working in global health, there are enough concerning signals that action should already be happening. So that if a certain set of mutations do occur and we see an outbreak in humans in Peru or China or Britain, that the harm it could cause is minimal. This is a disease with an estimated 50-60% fatality rate in humans, including children.  

The cornerstone of infectious disease preparedness is in: surveillance (to know what strain is spreading and where in birds); testing (to identify disease quickly in humans); vaccines (for protection against disease and death); and antivirals (to improve clinical outcomes). The US government is already moving in this direction. Rebecca Katz, professor at Georgetown University Medical Center, has noted that a H5 candidate vaccine virus recently produced by the US Centers for Disease Control and Prevention is likely to provide good protection against the circulating H5N1 viruses.  

The information has been shared with vaccine manufacturers to start the process of stockpiling adequate doses. But this is a challenge because most influenza vaccines are created by incubating doses in chicken eggs (called egg-based production). If bird flu has killed off many of the chickens, then egg shortages are likely. There’s another H5N1 vaccine which is non-egg based, but they could have a maximum of 150m doses ready within six months. The world’s population is almost 8 billion.  

In addition, the FDA-approved antiviral treatments for seasonal influenza could also work against bird flu. But again, getting doses to all parts of the world is a challenge given shortages. Preparation must also involve appropriate PPE for healthcare workers to protect against a respiratory disease (flu) and diagnostics to quickly identify if someone is infectious in hospitals.  

All of these issues are solvable with precise planning, collaboration across countries, scientific ingenuity and good leadership. With post Covid-19 fatigue, the bigger problem is bringing the public along and communicating the facts so that they are trusted and believed. With so much – often understandable – mistrust in our current political leadership, authorities like chief medical officers and independent government advisers become crucial.

From zero Covid to no plan: Behind China’s pandemic U-turn

Via The New York Times: From Zero Covid to No Plan: Behind China’s Pandemic U-Turn. Excerpt:

The southwestern city of Chongqing was the latest frontline of Xi Jinping’s “zero Covid” war, until it came to epitomize China’s potentially devastating about-face that has cracked the Communist Party’s edifice of absolute control.  

The city last month was enduring one of the biggest outbreaks cropping up across China, when the national leader, Mr. Xi, ordered officials to continue mass testing, lockdowns and quarantines. Chen Min’er, the Chongqing party secretary, devoutly complied, closing off neighborhoods and ordering the instant construction of a quarantine hospital designed to hold up to 21,000 beds.  

“Be resolute in fighting and winning this war of annihilation against the pandemic,” Mr. Chen, a protégé of Mr. Xi, told officials on Nov. 27. “Not a day of delay.”  

But 10 days later, China suddenly abandoned the “zero Covid” strategy on which Mr. Xi had staked his reputation. Now the country faces a surge of infections, and Mr. Xi has left officials scrambling to manage the disarray and uncertainty.

China’s party-run media has cast the shift as a stressful but well-considered exit, opening the way back to good economic times. Warnings about the dangers of the coronavirus have swiftly disappeared, replaced by official claims that the Omicron variant is generally mild. By holding off from easing until now, the government has saved many lives, the People’s Daily said on Thursday in a long article defending Mr. Xi’s pandemic strategy as “totally correct.”  

In reality, an examination of how the shift unfolded in Chongqing and elsewhere reveals a government overtaken by a cascade of Covid outbreaks, confusion over directives, economic woes and then rare political protests.  

Mr. Xi had contrasted his prior pandemic success with the “chaos of the West,” brandishing it as proof of his grand narrative of a rising China: orderly, secure, farsighted. But he had no plan for measured retreat from “zero Covid,” leaving a bewildered populace to improvise after three years of being micromanaged.  

The government is racing to approve vaccines and to obtain Western medicines after shunning them. Officials, long focused on eliminating cases, are struggling to marshal resources to treat an explosion of infections. Even the Chinese Communist Party, a virtuoso at controlling the narrative, is finding it difficult to sell the policy lurch to anxious residents.

US CDC begins agency-wide changes after pandemic failures

Via The Lancet: US CDC begins agency-wide changes after pandemic failures. Excerpt:

The US Centers for Disease Control and Prevention (CDC) is on a mission to reorganise and modernise itself, so that its mistakes during the pandemic will not happen again. The aim is to make the nation's leading disease detective more nimble and accountable, and fortify its role as public health protector. But although some changes have been made, progress will be limited without support from the US Congress. 

The CDC's Director, Rochelle Walensky, an infectious disease physician and research scientist appointed by President Joe Biden in January, 2021, commissioned an independent review of the CDC's pandemic record in April, conducted by James McCrae, Associate Administrator for Primary Health Care in the Department of Health and Human Services’ Health Resources and Services Administration. “To be frank, we are responsible for some pretty dramatic, pretty public mistakes, from testing to data to communications”, Walensky told her roughly 11 000 staff when she unveiled a summary of the review's findings in August (panel).  

Panel  

Key findings and recommendations from the CDC review  

It takes too long for the CDC to publish its data and science for decision making  

• Create an online mechanism for pre-publication delivery of science  

• Expedite the review or approval process for scientific publications and data (including laboratory data) to match the needs of the emergency  

The agency's turnover of staff during the COVID-19 response created gaps and other challenges for partners   

• Increase the number of CDC leaders trained and ready to deploy to a response  

• Require a minimum of 6-month rotation for leadership positions on the response; build a redundancy model of emergency staffing (ie, backup or co-lead staff in all key positions) to prevent response burnout and assure continuity in operations  

The agency's guidance documents are confusing and overwhelming, and the website is not easy to navigate  

• Produce plain-language, easy-to-understand implementation guidance documents that apply over multiple settings; reduce the number and length of guidance documents; include a brief scientific rationale or background in the implementation guidance with a referenced or accompanying Morbidity and Mortality Weekly Report, Science Brief, as necessary  

• Restructure the agency web site and digital communication platforms to eliminate unnecessary content and focus on key target audiences with a primary emphasis on the public  

COVID-19 uncovered the need for flexibilities that do not exist today at the CDC  

• Establish new authorities that will allow the CDC to be more nimble and work faster, such as public health and regulatory authorities mandating data collection from local jurisdictions, and human resource authorities with authority to hire faster, and ensure competitive salaries to recruit and retain for hard-to-fill positions like data scientists

The next pandemic? More likely a polydemic

Last week The Tyee published my article The Next Pandemic? More Likely a Polydemic. After going through a number of unpleasant problems in global health, I concluded:

These are just some of the threats in the present polydemic, which itself is part of the present hot mess of economic decline, rising prices, war, climate change and political polarization that writers like Adam Tooze are calling a polycrisis. And it’s precisely now that Canadian health spending should be rising to support pandemic preparation and prevention, not levelling off.  

From a political point of view, lower spending makes sense. The system is still trying to catch up with all the knee and hip replacements postponed for the last two years. Inflation makes it impossible to raise taxes, and the deficit spending that kept everyone afloat in 2020 and 2021 is now politically unacceptable.  

Besides, governments have learned that they don’t have to take pandemics as seriously as they once did. Provincial governments that let COVID-19 rip have been re-elected. Public health measures like masks and vaccine mandates have triggered a populist backlash that some politicians are exploiting. Health-care workers are exhausted, underpaid and embittered.

So even if a government wanted to take the polydemic seriously, and to build up the system against future pandemics, it would face serious resistance from many voters, not to mention the business sector. Rebuilding health-care staff numbers and infrastructure would take billions, spent over more years than any government is likely to survive. Short-term emergencies would always take priority over long-term needs.  

And when the next pandemic arrived and became a short-term emergency, neither governments nor the governed would implement or accept even proven measures to protect public health. They’d recycle COVID-19 misinformation as precedent: “It was mostly mild, it only killed old people, we got through it.”  

But if it’s a pandemic as lethal as H5N1 or Ebola, which has an average case fatality rate of 50 per cent, the survivors will think otherwise.

Before 2020, the pandemic anticipators I called Flublogia were certainly worried about the impact of a new influenza or other virus. But we still had a naive faith that while it would be bad, we in North America and western Europe and Japan would have the technology and the experts to deal with it.

The response of the western nations, and especially the US, was and is a disgrace and a revelation: just as the fearsome Russian army turned out to be stupid and incompetent, so have the health systems and politicians of the "advanced" nations. If the next virus turns serious, I really doubt whether the public will listen to the advice of the health experts. Nor will healthcare workers be willing to resist another onslaught. And that, of course, will only make matters much, much worse,

The politics of public health investments

Via PubMed, a discouraging but all too believable study: The politics of public health investments. The abstract:

Public health investments help to prevent mortality and reduce health care costs. Yet very few studies have examined the determinants of preventive care investments across countries and over time. We develop a theory of health spending priorities contrasting preventive and curative care. 

Preventive care is particularly unlikely to be prioritized by governments since it is a public good that requires the allocation of scarce resources in the present to generate diffuse benefits that unfold only in the long-term. As such, public health is a "quiet" policy that is not supported by interest groups or public opinion. 

These characteristics have two implications: like other long-term investments, public health programs are particularly vulnerable to fiscal austerity, and prevention expenditures are not influenced by government partisanship since parties cannot attract votes with such low visibility, long term investments. 

We use a dataset covering 25 OECD countries from 1970 to 2018 to demonstrate that fiscal consolidations are negatively associated with the absolute level of preventive care and with its proportion relative to curative care. 

We also confirm that left-wing governments are not more likely to invest in public health than right-wing governments. 

Finally, contributing to the literature on comparative health care systems, we show that National Health Services systems maintain higher preventive care investments than Social Health Insurance systems.

Early warning, alert and response to acute public health events in refugee-hosting countries

ECDC has published Early warning, alert and response to acute public health events in refugee-hosting countries. Click or tap through to download the document.

This document serves as an advocacy and quick assessment tool for public health responders in refugee-hosting countries to evaluate and strengthen EWAR capacities in two principal settings: 1) refugee reception centres or temporary shelter facilities, taken together as ‘high occupancy settings’, where refugees congregate overnight in close conditions, and 2) the community, or settings with living conditions similar to those of other residents. 

It does not intend to propose that new structures be established in parallel to replicate already well-functioning systems, but rather to look at opportunities to strengthen core capacities and ensure epidemic threats are appropriately monitored to allow for timely detection and response – especially in scenarios where new health care settings may need to be assessed, scaled up and linked to already established systems.

World in no better place to fight pandemics than before COVID

Via Reuters: World in no better place to fight pandemics than before COVID - review. Excerpt:

LONDON, May 18 (Reuters) - The world is no better prepared for a new pandemic than it was when coronavirus emerged in 2019 and may actually be in a worse place given the economic toll, according to a panel set up by the World Health Organization (WHO) to evaluate the global response.  

A lack of progress on reforms such as international health regulations means the world is as vulnerable as ever, the Independent Panel for Pandemic Preparedness and Response said in its report.  

The authors, led by former New Zealand prime minister Helen Clark and former president of Liberia Ellen Johnson Sirleaf, acknowledged some progress, including on more robust funding for the WHO, but said the process was going far too slowly.  

"We have right now the very same tools and the same system that existed in December 2019 to respond to a pandemic threat. And those tools just weren't good enough," Clark told reporters.  

"If there were a new pandemic threat this year, next year, or the year after at least, we will be largely in the same place ... maybe worse, given the tight fiscal space of many, if not most, countries right now."  

Wednesday's report comes ahead of next week's World Health Assembly in Geneva, the WHO's annual decision-making forum, which is expected to address some of the issues raised.

Evaluation of science advice during the COVID-19 pandemic in Sweden

Oh boy. This is devastating. Via Nature.com, an article in Humanities and Social Sciences Communications: Evaluation of science advice during the COVID-19 pandemic in Sweden. The abstract:

Sweden was well equipped to prevent the pandemic of COVID-19 from becoming serious. Over 280 years of collaboration between political bodies, authorities, and the scientific community had yielded many successes in preventive medicine. Sweden’s population is literate and has a high level of trust in authorities and those in power. During 2020, however, Sweden had ten times higher COVID-19 death rates compared with neighbouring Norway. 

In this report, we try to understand why, using a narrative approach to evaluate the Swedish COVID-19 policy and the role of scientific evidence and integrity. We argue that that scientific methodology was not followed by the major figures in the acting authorities—or the responsible politicians—with alternative narratives being considered as valid, resulting in arbitrary policy decisions. 

In 2014, the Public Health Agency merged with the Institute for Infectious Disease Control; the first decision by its new head (Johan Carlson) was to dismiss and move the authority’s six professors to Karolinska Institute. With this setup, the authority lacked expertise and could disregard scientific facts. 

The Swedish pandemic strategy seemed targeted towards “natural” herd-immunity and avoiding a societal shutdown. The Public Health Agency labelled advice from national scientists and international authorities as extreme positions, resulting in media and political bodies to accept their own policy instead. 

The Swedish people were kept in ignorance of basic facts such as the airborne SARS-CoV-2 transmission, that asymptomatic individuals can be contagious and that face masks protect both the carrier and others. Mandatory legislation was seldom used; recommendations relying upon personal responsibility and without any sanctions were the norm. Many elderly people were administered morphine instead of oxygen despite available supplies, effectively ending their lives. 

If Sweden wants to do better in future pandemics, the scientific method must be re-established, not least within the Public Health Agency. It would likely make a large difference if a separate, independent Institute for Infectious Disease Control is recreated. 

We recommend Sweden begins a self-critical process about its political culture and the lack of accountability of decision-makers to avoid future failures, as occurred with the COVID-19 pandemic.

Global Health Security Index: We haven't learned a damn thing

The Global Health Security Index came in for some deserved ridicule in 2020 when it declared the US health system as the best-prepared for a pandemic. But its latest report heaps scorn back on almost everyone, especially wealthy nations. As we stumble into the third year of this pandemic, such failure to prepare is inexcusable. An excerpt from its latest Report & Data:

Overall Finding

Although many countries were able to quickly develop capacities to address COVID-19, all countries remain dangerously unprepared for meeting future epidemic and pandemic threats. A great opportunity exists, however, to make new capacities more durable to further long-term gains in preparedness.

Additional Findings

Most countries, including high-income nations, have not made dedicated financial investments in strengthening epidemic or pandemic preparedness. 

• The overall average score for national-level financing is 35.2 out of 100.  

• 90 countries have not fulfilled their full commitment to contribute to the WHO; of those, 14 are high-income countries.  

• 66 countries have not identified special emergency public financing mechanisms and funds that the country can access in the face of a public health emergency; of those, 32 are high-income countries.  

• 155 countries have not allocated nonemergency national funds within the past three years to improve their capacity to address epidemic threats; among those, only two low-income countries have evidence of allocated funds.  

• The average score for national financing for epidemic preparedness is 21 out of 100; low-income countries have an average score of 7 out of 100.  

• Financing for emergency response has a global average score of 66.  

• High-income countries have the lowest average score of 46; low-income countries have the highest average, with 93.  

• Only four countries (Eritrea, Indonesia, Liberia, and Timor-Leste) have a JEE or NAPHS that describes specific funding from the national budget to address previously identified gaps.  

• High-income and upper-middle-income countries receive the lowest scores for financing when reviewed under the JEE and OIE Performance of Veterinary Services (PVS) Pathway assessments and related to financing for emergency response.  

• The average score for financing under the JEE and PVS report is 1 out of 100; this score reflects the provisions for funding IHR implementation through the national budget or other mechanisms.