H5N1

The global community needs to do more to tackle the inequality crisis

Via The BMJ, an opinion piece by Sir Michael Marmot, Monica Geingos, and Joseph E. Stiglitz: The global community needs to do more to tackle the inequality crisis.

Progress on health inequalities is now at risk, argue Michael Marmot and colleagues, the chairs of a new Global Council on Inequality, AIDS, and Pandemics.

The climate emergency and the global rise in inequalities are putting us all at risk. Both will damage health. The global community, with successive climate change conferences (COPs), is taking faltering steps to tackle the climate emergency but is doing little about the inequality crisis. In some countries, political and economic forces are increasing social and economic inequalities, with potentially dire consequences for health inequalities and for people’s vulnerability to pandemics. Unfair distribution of power, money, and resources are driving inequalities in health. 

We’ve been through a good period. Global progress in improving health has been impressive throughout the 20th and early 21st centuries, and health inequalities between countries have diminished. Within countries, too, absolute inequalities in health have lessened, although that picture is more mixed.   

But this progress is now at risk. If the AIDS and covid-19 pandemics did nothing else, they showed how fragile these health improvements are. These pandemics have, to some extent, been driven by social and economic inequalities, and their effects have been to expose and exacerbate health inequalities. The effects of the pandemics have also been disproportionate in some communities and related to socioeconomic circumstances, gender, LGBTQ+ identities, and race and ethnicity.  

To deal with the effects of inequalities on pandemics and of pandemics on health inequalities, the Joint United Nations Programme on HIV/AIDS (UNAIDS) has convened the Global Council on Inequality, AIDS, and Pandemics. We are the co-chairs of this global council. The announcement of the new council was made in Brazil at a meeting hosted by the Brazilian Ministry of Health. Our backgrounds as co-chairs are highly relevant to the council’s mission. We seek to bring the perspectives of international and national economic arrangements, social determinants of health, and human rights to bear on our central questions. The need is great as the following examples show.  

Analyses indicate that countries with greater income inequality have higher rates of HIV infection and of death from AIDS and covid-19. In most, but not all, African cities the urban poor are much more likely to live with HIV than those from higher socioeconomic groups.

HIV and AIDS have also exposed gender inequalities. In the west African countries of Cote d’Ivoire, Ghana, and Liberia, HIV prevalence in people aged 20-24 was five times higher in women than in men.

The unequal effect of the AIDS pandemic on men who have sex with men is a political choice. In Thailand, for example, where identifying as LGBTQ+ is not criminalised, the prevalence of HIV is 12 times higher among men who have sex with men than among other adults. In Malaysia, where identifying as LGBTQ+ is criminalised and subject to arrest, the HIV prevalence rate among men who have sex with men is more than 70 times higher than among other adults.

In Brazil, where racial inequalities were not openly acknowledged for a long time, the evidence of the effects of this on health inequalities is stark. Rates of new HIV infections have been falling among white people, while rising among black people.

The United States provides an important case study of the role of socioeconomic influences and racism on health, including during the covid-19 pandemic. Life expectancy had been falling in the years 2016-18, in part owing to deaths of despair, which show a social gradient—the fewer the years of education, the bigger the effect. The decline stopped, and life expectancy rose slightly in 2019, but then fell sharply in the first two years of the covid-19 pandemic. Covid mortality was higher among socioeconomically disadvantaged communities and black people. In New York City, in the first year of the pandemic, life expectancy fell by three years among white residents, 5.5 years among black residents, and six years among Hispanic residents.

The AIDS and covid-19 pandemics send two clear messages, and hopefully the global community is open to receiving them. The first is that inequalities drive the likelihood and consequences of pandemics, and pandemics amplify health inequalities. This is the problem that this global council is set up to tackle.

The second is that medical and technical responses are crucial but are only part of the story. Inequities in access to care are needless, harmful, and immoral, and should be relatively easy to solve. Could there have been a global rollout of covid vaccines, entailing higher levels of production? Most certainly. Technically, it should be possible in future pandemics to have the capacity to vaccinate the world as needed. The money is certainly there. In the first year of the covid-19 pandemic, the rich world found $18tn to protect the economies of high income countries. Against this amount, $25bn for a global rollout of the vaccine is coffee money. And the technology that would have made it even easier to rollout the vaccine more widely wasn’t shared, even though governments had put up the vast majority of funds for vaccine development. As the old saying has it, this was penny wise but pound foolish because everyone would have benefited from dampening down covid-19 globally.

The effects of transnational economic inequalities are striking. During the covid-19 pandemic, high income countries put trillions into health and social spending to fight the pandemic’s effects, including supporting their economies, but low and middle income countries lacked the fiscal resources to make this choice. In 2021, almost half of all low and middle income countries cut healthcare spending, and about 70% cut spending on education.

The clear lessons from pandemics are that paying attention to the social determinants of health, respecting human rights, and involving communities are critical. Inequalities in health this vast are not inevitable. They are the result of policies—both what we do and what we fail to do. To achieve a world with better health and fewer health inequalities we need knowledge, resources, and political will. One of the tasks of the Global Council on Inequality, AIDS, and Pandemics is to synthesise the knowledge we already have. As the example of the money found by high income countries to protect their economies shows, “we”—the global community—also have the resources. The problem is the skewed distribution of financial and other resources. Political will is the great challenge. The global council will work with partners in governments, agencies, and communities to build the political will and public demand for change. Social justice requires it.

Outcomes and characteristics of patients hospitalized for COVID-19 in British Columbia, Ontario and Quebec during the Omicron wave

Thanks to FluTrackers for alerting me to this report in CMAJ Open: Outcomes and characteristics of patients hospitalized for COVID-19 in British Columbia, Ontario and Quebec during the Omicron wave. The abstract:

Background: Omicron is the current predominant variant of concern of SARS-CoV-2. We hypothesized that vaccination alters outcomes of patients hospitalized with COVID-19 during the Omicron wave and that these patients have different characteristics and outcomes than in previous waves. 

Methods: This is a substudy of the Host Response Mediators in Coronavirus (COVID-19) Infection (ARBs CORONA I) trial, which included adults admitted to hospital with acute COVID-19 up to July 2022 from 9 hospitals in British Columbia, Ontario and Quebec. We excluded emergency department visits without hospital admission, readmissions and admissions for another reason. Using adjusted regression analysis, we compared mortality and organ dysfunction between vaccinated (≥ 2 doses) and unvaccinated patients during the Omicron wave, as well as between all patients in the Omicron and first 3 waves of the COVID-19 pandemic.  

Results: During the Omicron wave, 28-day mortality was significantly lower in vaccinated (n = 19/237) than unvaccinated hospitalized patients (n = 12/127) (adjusted odds ratio [OR] 0.36, 95% confidence interval [CI] 0.15–0.89); vaccinated patients had lower risk of admission to the intensive care unit, invasive ventilation and acute respiratory distress syndrome and shorter hospital length of stay. Patients hospitalized during the Omicron wave had more comorbidities than in previous waves, and lower 28-day mortality than in waves 1 and 2 (adjusted OR 0.38, 95% CI 0.24–0.59; and 0.42, 95% CI 0.26–0.65) but not wave 3 (adjusted OR 0.81, 95% CI 0.43–1.51) and had less organ dysfunction than in the first 2 waves.  

Interpretation: Patients who were at least double vaccinated had lower mortality than unvaccinated patients hospitalized during the Omicron wave. Patients hospitalized during the Omicron wave had more chronic disease and lower mortality than in the first 2 waves, but not wave 3. Changes in vaccination, treatments and predominant SARS-CoV-2 variant may have decreased mortality in patients hospitalized during the Omicron wave.

China’s rolling COVID waves could hit every six months — infecting millions

Via Nature: China’s rolling COVID waves could hit every six months — infecting millions. Excerpt:

The latest surge in COVID-19 cases in China is not surprising to researchers, who say that China will see an infection cycle every six months now that all COVID-19 restrictions have been removed and highly infectious variants are dominant. But they caution that rolling waves of infection carry the risk of new variants emerging.  

“Unfortunately, a new reality with this virus [is that] we will have repeated infections,” says Ali Mokdad, an epidemiologist at the Institute for Health Metrics and Evaluation at the University of Washington in Seattle. “The fear is that this virus will produce a new variant that can compete with the current ones and is more severe.”  

The current surge is caused mainly by a highly infectious subvariant of Omicron called XBB.1.5, first identified in India last August. According to Nanshan Zhong, a prominent respiratory physician in China, as many as 65 million people could become infected per week by the end of June.  

This is the first major reinfection wave that China has seen since the central government dropped all its COVID-19 control measures in December, prompting a widespread Omicron outbreak.  

China has vaccinated more than 90% of its population, and the outbreak in December infected at least 85% of its people, says Zhong. But immunity is waning, and XBB can evade protection from vaccines and prior infections. Mokdad says that, although XBB has not caused a major rise in hospitalizations and deaths, the sheer number of infections could put pressure on China’s health-care system.  

XBB is also causing minor waves in other parts of the world, such as Singapore and the United States.  

“This is what we see everywhere, but with a large population such as China, it is more apparent,” says Mokdad.  

Yunlong Cao, an immunologist at Peking University in Beijing, and his team have found that antibodies generated against Omicron variants BA.5 and BF.7, the dominant strains during the December wave in China, can provide about four months of protection against strains such as XBB.  

Kayoko Shioda, an epidemiologist at Boston University in Massachusetts, says that previous COVID-19 surges in other countries have shown that XBB is more transmissible than earlier forms. “Once it enters the population, XBB spreads and becomes the predominant variant much quicker than other variants,” she says.  

Last December, more than 200 million people in China contracted COVID-19 in 20 days. This time, the wave is spanning several months, owing to the differences in people’s immune backgrounds, such as antibody levels, says Cao.  

“The peak of COVID-19 waves will generally become flatter and more stretched out after each cycle, which is a pattern we see in countries like the US. People are still getting infected in the US, just not all at once,” he adds. A flatter wave would also lessen the burden on health-care systems, Cao says.

Animal health body urges bird flu vaccination to avoid pandemic

Via Reuters: Animal health body urges bird flu vaccination to avoid pandemic. Excerpt:

PARIS, May 21 (Reuters) - Governments should consider vaccinating birds against bird flu to avoid the virus - which has already killed hundreds of millions of birds and infected mammals worldwide - turning into a new pandemic, the head of the World Animal Health Organisation (WOAH) said.  

The severity of the current outbreak of avian influenza, commonly called bird flu, and the economic and personal damage it has caused, has led governments to reconsider vaccinating poultry. However, some, like the United States, remain reluctant mainly because of the trade curbs this would entail.

"We are coming out of a COVID crisis where every country realised the hypothesis of a pandemic was real," WOAH Director General Monique Eloit told Reuters in an interview.  

"Since almost every country that does international trade has now been infected, maybe it's time to discuss vaccination, in addition to systematic culling which remains the main tool (to control the disease)," she said.  

The WOAH is holding a five-day general session from Sunday, and will be focus on global control of highly pathogenic avian influenza, or HPAI. 

A WOAH survey showed only 25% of its member states would accept imports of products from poultry vaccinated against HPAI.  

The European Union's 27 member states agreed last year to implement a bird flu vaccine strategy. France is set to be the first one, starting with ducks in the autumn.  

"If a bloc like the EU, which is a large exporter, starts moving in that direction, it will have a ricochet impact," Eloit said.  

The U.S. department of Agriculture (USDA) told Reuters on Friday that "in the interest of leaving no stone unturned in the fight against HPAI, USDA continues to research vaccine options that can protect poultry from this persistent threat".  

However, it still considers biosecurity measures to be the most effective tool for mitigating the virus in commercial flocks, it said in emailed answers.

Progress toward regional measles elimination — worldwide, 2000–2021

Via MMWR: Progress Toward Regional Measles Elimination — Worldwide, 2000–2021. The summary:

What is already known about this topic?  

Progress toward measles elimination experienced setbacks in 2020 during the COVID-19 pandemic.  

What is added by this report?  

During 2000–2021, measles vaccination prevented an estimated 56 million deaths worldwide. In 2021, only 81% of children received their first dose of measles containing vaccine (MCV), the lowest coverage reported since 2008, leaving 25 million children vulnerable to measles. Measles surveillance continues to be suboptimal, and large and disruptive outbreaks were reported in 22 countries.  

What are the implications for public health practice?  

Reaching all children with 2 doses of MCV and strengthening measles surveillance is critical to close immunity gaps, prevent outbreaks, and recover progress lost during the pandemic.

Excess death rates for Republicans and Democrats during the COVID-19 pandemic

Via the National Bureau of Economic Research: Excess Death Rates for Republicans and Democrats During the COVID-19 Pandemic. The abstract:

Political affiliation has emerged as a potential risk factor for COVID-19, amid evidence that Republican-leaning counties have had higher COVID-19 death rates than Democrat- leaning counties and evidence of a link between political party affiliation and vaccination views. 

This study constructs an individual-level dataset with political affiliation and excess death rates during the COVID-19 pandemic via a linkage of 2017 voter registration in Ohio and Florida to mortality data from 2018 to 2021. We estimate substantially higher excess death rates for registered Republicans when compared to registered Democrats, with almost all of the difference concentrated in the period after vaccines were widely available in our study states. 

Overall, the excess death rate for Republicans was 5.4 percentage points (pp), or 76%, higher than the excess death rate for Democrats. Post-vaccines, the excess death rate gap between Republicans and Democrats widened from 1.6 pp (22% of the Democrat excess death rate) to 10.4 pp (153% of the Democrat excess death rate). 

The gap in excess death rates between Republicans and Democrats is concentrated in counties with low vaccination rates and only materializes after vaccines became widely available.

WHO sees October COVID surge in Ukraine, cites polio concerns

Via Reuters: WHO sees October COVID surge in Ukraine, cites polio concerns. Excerpt:

JERUSALEM, Sept 12 (Reuters) - The World Health Organisation expects a rise in COVID-19 in Ukraine to peak in October, possibly bringing hospitals close to their capacity threshold, WHO's director-general Tedros Adhanom Ghebreyesus said on Monday.  

"We are now seeing an increase in cases of COVID-19 in Ukraine. We project that transmission could peak in early October and hospitals could approach their capacity threshold," Ghebreyesus told WHO'S Regional Committee for Europe conference in Tel Aviv.  

"Oxygen shortages are predicted because major supply sources are in occupied parts of the country," he said. Oxygen is essential for patients with a range of conditions, including COVID-19 and those with other critical illnesses stemming from complications of pregnancy, childbirth, sepsis, injuries and trauma.  

Russia's February invasion of Ukraine has greatly impacted healthcare, with the WHO confirming more than 500 attacks on health infrastructure there, resulting in some 100 deaths. Ghebreyesus also said that the war could increase polio spread. 

"We are also deeply concerned about the potential for the international spread of polio due to the gaps in immunization coverage and mass population movement linked to the war," he said.  

Ukraine has low vaccination coverage for both COVID and polio, an infectious disease mainly affecting children that can cause paralysis and kill in rare cases. Two cases of polio were reported in Ukraine in 2021.

Defining immunization: Types, statistics, and resources

Thanks to Regis College Online for sending the link to this resource just before World Immunization Week: Defining Immunization: Types, Statistics, and Resources. Click through to see the very good infographic on immunization. The introduction:

Immunization prevents an estimated 2 to 3 million deaths per year, according to the World Health Organization (WHO). The administration of vaccines has increased significantly over the last century, and developments in the field continue to improve and strengthen them. It’s important for every individual to understand the different types of vaccines and stay aware of recommendations for immunizations put forth by public health organizations.

Ebola in Mbandaka: No new confirmed case for a week

Via Provinces 26 RDC: DRC-Ebola in Mbandaka: no new confirmed case for a week. The Google translation, slightly edited:

No new confirmed case of the Ebola virus disease has been recorded for a week, to the day, in the city of Mbandaka in Equateur province. The last case was recorded on April 25, and died a day later.  

The latest data made public by the health authorities show a total of 2 confirmed cases, a man and a woman [all deceased], in the health zone of Mbandaka alone. 

Since Wednesday April 27, the vaccination campaign against Ebola has been launched. It concerns people who have come into contact with a patient suffering from Ebola, as well as front-line workers.  

So far, 175 people have been vaccinated. The total number of contacts listed is 334 people.  

Meanwhile, the Governor of Equateur calls on the population to be vigilant and to respect the health measures enacted, in order to stop the spread of this epidemic.  

In a message made public, Governor Bobo Boloko asks residents to immediately refer suspected cases within their various entities to nearby health structures for appropriate care.  

"Our province is now in an epidemic of the Ebola virus disease. I want to inform you that it is a very dangerous, contagious and often fatal disease. It is transmitted by direct contact with blood, urine, stool, vomit, saliva, semen, vaginal secretions, sweat and manipulation of the body of a patient with or who has died of Ebola. And by the consumption of wild and domestic animals found dead. In case of headache, fever, abdominal pain, hiccups, vomiting, diarrhea, rash, red eyes and sometimes bleeding. This is why before eating, preparing, breastfeeding and changing babies' diapers, after the toilet, on returning home, we wash our hands with soap and clean water. 

Note that this 14th Ebola epidemic has been officially declared in Mbandaka. This is the third outbreak in this province since 2018.

Mbandaka: ISTM takes measures to secure its students against the new Ebola epidemic

Via Radio Okapi, we learn that the first Ebola case was a medical student: Mbandaka: ISTM takes measures to secure its students against the new Ebola epidemic. The Google translation:

The Higher Institute of Medical Techniques (ISTM) took measures, including vaccination, to secure its students and limit the spread of Ebola, 48 hours after the declaration of the epidemic in Mbandaka by the central government.   

The first confirmed and deceased case was student Yange Bononga, enrolled in the 3rd Nutrition graduate, for the 2021-2022 academic year.   

Thus the management committee meeting on Monday, April 25 asked for the cooperation of the students and the support of the competent services.   

Among these measures taken, there is the awareness of students on the existence of the disease, the respect of barrier gestures and the obligation to present themselves free of charge to the hospital in the event of illness.   

In addition to the installation of washbasins in front of the strategic corners of the institute, the committee also requested the vaccination of the entire ISTM community, particularly the students of the 3rd Nutrition graduate.      

In addition, the ISTM has launched an appeal to public health services and humanitarian organizations to help build its capacity in information and protective equipment. Thus, a conference-debate on the resurgence of the Ebola virus disease in Ecuador is planned this week.   

All these measures are taken, continues the management committee, following the instructions of the minister in charge, to help curb the epidemic.    

Some students unfortunately had contact with the victim during his final moments.   

The management committee clarified, however, that the victim would have contracted the disease during his return trip from the holidays of Boende, where he is from.   

Although he probably arrived on April 10 in Mbandaka, he was directly admitted to health centers without attending the institute. This, until his hospitalization at the Wangata General Reference Hospital, then at the Ebola treatment center, where he passed away.