Health Issues in Africa

Health Issues in Africa

Global Health

North Korea officially announces COVID-19 outbreak; The latest health stories from around the world

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Confirmed cases of COVID-19 concept. a covid-19 blood test tube with result of positive on yellow background the X has clipping path and can be removed. COVID-19 testing concept. Antibody tests concept. Image credit: 罗 宏志 / 123rf. COVID-19 cases now number at one million: concept. Testing illustration. Symptomatic COVID-19 illustration. Cases of COVID-19 in India concept. COVID-19 clusters concept.. new covid-19 variant mutant strain long covid. COVID-19 cases concept. Even after recovery from COVID-19, long-COVID symptoms may persist. Image credit: 罗 宏志 / 123rf. B.1.617 concept. black fungus. Delta plus variant concern. Delta variant concept. Excess mortality illustration. Fresh COVID-19 cases illustration.
Image credit: 罗 宏志 / 123rf

Even as most of the world rises to a slowly receding COVID wave, North Korea on Sunday reported 15 additional deaths from “fever” after the country recently announced its first-ever cases of COVID-19 and ordered nationwide lockdowns, television channel NDTV citing AFP reports said. www.ndtv.com/world-news/north-korea-coronavirus-north-korea-covid-north-korea-coronavirus-cases-north-koreas-explosive-covid-outbreak-820-620-cases-in-3-days-2977028

State media KCNA said a total of 42 people had died, with 820,620 cases and at least 324,550 under medical treatment.

Leader Kim Jong Un has said the outbreak has caused “great upheaval” in North Korea.

KCNA reported that “all provinces, cities and counties of the country have been totally locked down and working units, production units and residential units closed from each other.”

Despite activating its “maximum emergency quarantine system” to slow the spread of disease through its unvaccinated population, the nation of 25 million is now reporting large numbers of new cases daily.

North Korea confirmed 12 May that the highly contagious Omicron variant had been detected in the capital Pyongyang, with Kim ordering nationwide lockdowns.

It was the government’s first official admission of COVID cases and marked the failure of a two-year coronavirus blockade maintained since the start of the pandemic.

North Korea has a crumbling health system — one of the worst in the world – and, alarmingly, no COVID vaccines, antiviral treatment drugs or mass testing capacity.

It has previously turned down offers of COVID vaccines from China and the World Health Organization (WHO)’s Covax scheme, but both Beijing and Seoul have issued fresh offers of aid and vaccines.

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President Joe Biden on Thursday commemorated the COVID-19 deaths of 1 million people in the United States, marking what he called “a tragic milestone” and urging Americans to “remain vigilant” during the ongoing pandemic. In a statement, Biden acknowledged the impact of the deaths on families left behind and urged the country not to “grow numb to such sorrow.” The United States on Wednesday reached more than 1 million COVID-19 deaths, according to a Reuters tally, crossing a once-unthinkable milestone about two years after the first cases upended everyday life.

https://www.reuters.com/world/us/biden-marks-1-million-americans-dead-covid-2022-05-12/

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The US government says it’ll put licenses for 11 medical technologies developed at the National Institutes of Health (NIH) into a “patent pool”, something that promises to make it easier for low- and middle-income countries to gain access to vaccines, drugs, and diagnostics for COVID-19. President Joe Biden made the announcement Thursday at the Global COVID-19 Summit. (www.whitehouse.gov/briefing-room/speeches-remarks/2022/05/12/remarks-by-president-biden-at-the-global-covid-19-summit/)

The Biden government cut a deal to provide the US federally funded inventions with the COVID-19 Technology Access Pool, organised by the WHO. WHO then turns over the licences to a non-profit, the Medicines Patent Pool (MPP), which negotiates with manufacturers interested in using the technologies to make products that can be sold worldwide.

Created in 2010, MPP today has patent agreements for several anti-HIV drugs and recently added two treatments for COVID-19, Pfizer’s Paxlovid and Merck’s Molnupiravir. The new agreement also covers inventions used by companies that make existing COVID-19 vaccines, such as a modification that stabilizes spike, the surface protein of SARS-CoV-2. Companies could also use the technologies to make entirely new products. Research tools for drugmakers and diagnostic assays are also part of the agreement.

MPP forges deals with drugmakers that allow companies in the least developed countries to pay the lowest royalty fees—and some pay nothing at all. In many cases, however, the licenses in the NIH portfolio only remove one hurdle to making a vaccine or another product, which often require licensing agreements with several different patent holders.

www.science.org/content/article/pretty-big-deal-u-s-makes-covid-19-technologies-available-use-developing-countries?

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Shanghai officials outlined plans for a phased reopening of shopping malls, supermarkets and other businesses, even as many residents in China’s financial hub remained confined to their locked-down homes. Chen Tong, Shanghai’s deputy mayor, said Sunday that the city would begin allowing businesses to open on a limited basis starting Monday as daily COVID-19 infection cases continue to decline nearly two months into a hard lockdown of the city of 25 million people. Mr Chen characterized the city’s approach to the pandemic as entering a new transition phase, “from emergency response to normalized prevention and control.” On Sunday, Shanghai health authorities reported roughly 1,200 new COVID cases for the previous day, from a high of more than 20,000 last month. Daily infection counts have been below 5,000 for nearly two weeks.

https://www.wsj.com/articles/shanghai-lays-out-covid-19-reopening-plan-as-china-cancels-2023-soccer-tournament-11652619639?mod=hp_listb_pos1

Meanwhile, China says it would “strictly limit” travel abroad by Chinese citizens as the country doubles down on its “zero-covid” policies aimed at stamping out the virus. The National Immigration Authority also warned about visitors bringing COVID-19 into China. 

China’s struggle to end its latest outbreak of more than 500,000 cases of covid-19 is casting fresh doubts on the future of its zero-covid policy. In a paper published this week in Nature Medicine, Chinese scientists and their foreign colleagues model the alternatives. Dropping all lockdown restrictions would quickly lead to 1.6m deaths, and at the peak of the wave China would need 16 times more intensive-care beds than it currently has.

More realistic is a combination of vaccines and treatments. That, according to the scientists, could be sufficient to prevent the crush at hospitals. Treating all symptomatic cases with the most effective antiviral drugs would make the biggest difference. But huge amounts of the drugs must be procured. Vaccinating over-60s would also make a significant, though smaller, difference. Closing schools and workplaces, and other curbs on group activity, are much less effective—they only delay the problem in the same way that the zero-COVID policy does.

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The new strains didn’t have much of an impact initially, but over the past few weeks case numbers in South Africa jumped from roughly 1000 per day on 17 April to nearly 10,000 on 7 May. A third subvariant called BA.2.12.1 is spreading in the United States, driving increases along the East Coast.Epidemiologists and virologists are watching closely as cases in South Africa rise sharply again, just 5 months after the Omicron variant caused a dramatic surge. This time, the drivers are two new subvariants of Omicron named BA.4 and BA.5, which the Network for Genomic Surveillance in South Africa first detected in January, according to science.org (www.science.org/content/article/new-versions-omicron-are-masters-immune-evasion)

It’s still unclear whether the new subvariants will cause another global COVID-19 wave. But like the earlier versions of Omicron, they have a remarkable ability to evade immunity from vaccines, previous infection, or both—a disturbing portent for the future of the pandemic and a potentially serious complication for vaccine developers.

In most cases, vaccination or earlier infection still seem to provide protection from severe disease. “There’s no reason to freak out,” says John Moore, an immunologist at Weill Cornell Medicine. The new strains are “an additional hassle,” he says, but “there’s no indication that they’re more dangerous or more pathogenic.”

Hospitalizations in South Africa, for example, have increased, “but because it is starting from a very low level, it’s not cause for alarm,” says virologist Tulio de Oliveira of Stellenbosch University, who helped identify BA.4 and BA.5.

Omicron’s rapid evolution creates difficult decisions for vaccine- and policymakers about whether to shift to a new set of vaccines or stick with the current formulations, which are based on the virus that emerged in Wuhan, China more than two years ago. Moderna has tested two versions of its mRNA vaccine, containing the ancestral strain and either the Beta variant—which spread in South Africa for a while in 2021 but is now gone—or the Omicron BA.1 variant. The company has not yet reported data on how well they might protect against the new subvariants.

Pfizer, the other mRNA vaccine producer, has tested the efficacy of a booster and a primary vaccine based on BA.1. Results are expected by the end of June. The US Food and Drug Administration has scheduled a meeting for 28 June to analyse available data and make vaccine recommendations for the fall.

The limited protection that BA.1 infection provided against the new subvariants in lab studies has already raised questions about how useful the new Omicron-specific vaccines might be. Wang says the virus is evolving too quickly for strain-specific vaccines to keep up. Instead, a broad cocktail of monoclonal antibodies targeting different strains might be the best way forward, he says.

Such a shot could prevent infections for several months in those vulnerable to severe disease, including immunocompromised people who don’t respond to vaccines. Protecting that group is crucial, he notes, because many researchers suspect new variants emerge during long-term infections in people whose immune systems fail to clear the virus. The main hurdle, Wang says, is cost: A dose of monoclonal antibodies is about $,1000 per patient, he notes, “but if someone could find a way to lower that to $50 or $100,” the approach could be cheaper than constantly updating vaccines.

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 Lalita Panicker is Consulting Editor, Views and Editor, Insight, Hindustan Times, New Delhi

Global Elite are Bored with Health, Just When It’s Getting Really Exciting

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Following the Raisina Dialogue in India, global leaders continue to neglect the exciting and groundbreaking developments in global health. Many of these developments, if properly implemented, could see African nations create more effective health programmes than higher income countries who are overlooking key new technologies and discoveries. The following article was published by Mark Chataway after attending the Raisina Dialogue.

For the first time since 2019, the glitterati of geopolitics gathered recently at the Raisina Dialogue in New Delhi. Why, I asked a senior Indian diplomat, did most of them fail to even mention health. Had they learned nothing from the pandemic? The pandemic, he thought, was the problem. “They’ve had over two years of being forced to talk about health. Now, they want to get back to things they’re really interested in.”

Our global leaders may regret not paying more attention to what is happening in health: in the geeky panels where I lurked, there was a conviction that health technology and artificial intelligence may help middle income countries to leap past their more fossilised advanced counterparts within a decade.

The oppressive silence

President Ursula von der Leyen of the European Commission set the tone in her opening remarks: democracy versus autocracy; the climate emergency and; helping global trade to recover and reorganise. She did mention health once, but only in the context of a pandemic that was now waning. And, President von der Leyen is a doctor by training, with a master’s degree in public health! The assorted foreign ministers and heads of development finance institutions did not, as far as I could tell, have a medical degree between them, so it’s maybe unsurprising that they glossed over the topic too. 

In fairness, Tadashi Maeda, the Governor of the Japan Bank for International Cooperation did talk about investment in Indian vaccine and small molecule production. I may have missed other contributions: each day began at 9am and ended 10.30pm; there were multiple breakout sessions twice a day and; all of the lunches and dinners were by invitation only. To no-one’s surprise, I was invited to the mealtime discussion on health issues around cooking oil rather than the exclusive meal hosted by the Indian foreign minister. 

Overall, though, I’m fairly sure that economy and finance leaders from across Africa, Asia, Europe and Latin America skipped any mention of the transformative approach to health that was the subject of so many promises from so many leaders throughout the pandemic. Geoffrey Onyeama the Minister of Foreign Affairs of Nigeria even managed about fifteen very eloquent minutes on the post-pandemic economic architecture without once touching on prevention, diagnosis or treatment of anything. 

Silence is sometimes welcome. In mediaeval Madrid or Rome, it must have been a relief not to be required to appease the Inquisition by applauding yet another lecture on how the sun revolved around the Earth; at Raisina, we were spared too many doctrinal lectures on the need for vaccine and medicines production in every back yard. At a meal in an outside restaurant, where each of us looked over our shoulder frequently to check that our heresy wasn’t being overheard, I spoke to a senior adviser to an African president who agreed that there was no sign anyone would pay a premium for products produced in Africa and that those products would inevitably be much more expensive than vaccines and medicines from highly efficient factories in India and in the advanced economies. Just look at South Africa’s Aspen, he said. 

Why it was better to be with the geeks

The Raisina organisers had made sure that, wherever the attention of the geopoliticians wandered, health would have protected sessions. The briefing book had a number of thought-provoking articles and I was lucky enough to be on the panel of a discussion about “Healthcare, Technology and a Coalition of the Willing” (warning: it’s an 85-minute video).  

The G20 will be chaired by emerging economies for the next three years (assuming a compromise can be found over Russia’s position in it). Indonesia’s turn is first. Dino Patti Djalal, the Chairman of Foreign Policy Community of Indonesia, and a former ambassador to the US, said that data and the rules governing access to it would be a focus of its presidency. In a world that has become used to COVID apps as a prerequisite to normal life, he saw vast opportunities for technology to transform healthcare delivery, but no guarantee that it would — more about this in a moment. Indonesia is also pushing for an “IMF of health” that would act as a shared funding pool for countries facing health crises and the G20 is establishing a continuing task force that brings together health and finance ministers. As workforces age, health becomes an ever more vital prerequisite to economic growth.

India, which takes over the G20 in 2023,  has committed massively to digitisation transforming health in a country that will very soon be the world’s most populous. At a Federation of Indian Chambers of Commerce meeting on a road map for universal health care earlier this year, experts defended plans to have many fewer beds per thousand of population than the global norm by saying that screening and remote management would mean that every bed would be used efficiently. It’s not a pipe dream: multiple emergency rooms in Gujarat are already managed by one specialist supervising local teams of doctors and nurses who act as arms and legs; across Bihar, one of India’s most deprived states, kiosks staffed by paramedics with very basic training link to a call centre staffed by GPs and specialists in Delhi who can send prescriptions, order diagnostic tests or refer the patient immediately.

Preeti Sudan, the Health Secretary who oversaw India’s initial forceful response to COVID, said that the country could not have managed the pandemic without AI predicting emerging hotspots. Nor could it have delivered 1.85 billion vaccine doses of COVID vaccines. 

India takes the potential of artificial intelligence in health so seriously that it has seconded a full ambassador to run I-DAIR, a Geneva-based international collaborative. In the future, massive databases are likely to be more prized assets than a collection of patents or closed collaborations with academic centres. Ambassador Amandeep Gill foresees an alliance of small states and large low and lower-middle income countries. The Switzerlands and Singapores will bring money and expertise; the populous countries will bring data and the chance to find patterns that will transform diagnosis treatment (and fast-emerging health tech hubs in countries such as India and Kenya).

Change, though, is frightening. In many situations, AI can already predict more accurately than humans which pathogen is likely to be responsible for a patient’s infection and can predict which antibiotics are likely to work against it. Why do you need a doctor? This kind of change will be even more profound in areas such as cancer and management of cardiovascular disease. Ss Ambassador Djalal said, “doctors are enormously egotistical, especially when it comes to their revenues”. We need, he said, to prepare for political and social resistance from those who’ve benefited from the current system. 

The last time I saw the figures, Indonesia had fewer than 200 medical oncologists for about 270 million people. If they are worried, imagine how the average American oncologist will feel: there are about 13,000 of them for a population that is only 20% bigger than Indonesia’s. They earn an average of $300,000 a year, according to Glassdoor. As South African minister Kwati Candith Mashego-Dlamini told the panel, health technology will allow South Africa to spread its few oncologists more thinly; that should be what worries the office-based oncologist in Topeka. No one is suggesting that there will be no role for oncologists or cardiologists in the future; just that their role will be different, and probably less well paying. 

The Americans and the Europeans are likely to resist for longer: there are more of them and they account for a much larger percentage of GDP than do their counterparts in middle income countries. Today, Indians can get some cardiovascular surgery with a better chance of survival and at prices as low as two percent of the cost of the procedure in the USA. This achievement was reported by INSEAD, Europe’s leading business school in 2012, but the Indian model has yet to be replicated in Europe or North America.  It is likely, then, that AI-driven healthcare will reach its full potential in India and Indonesia before it does in the United Kingdom or the United States. The advanced economies will probably be late adopters, not refusers, though.

Power will shift in medical research too. A New Scientist article explained it beautifully in 2019. “Because all humans originated in Africa, groups that later migrated elsewhere took only a fraction of genetic diversity with them. Two individuals within an African population will be much more different than two individuals within a European population…The higher level of genetic diversity within Africa gives researchers the opportunity to investigate whether particular gene variants are associated with particular diseases. “For example, if you had a gene that was not variable at all in Europeans, you could not find an association with disease,” says [a researcher].  If there was variability in the same gene in people of African descent, that could lead to the development of a drug that could be used globally.” 

In the new era, Europeans and North Americans will discover that their majority populations are genetically impoverished, while minorities at home and — even more so — people still living in Africa and South Asia hold the key to new medical interventions. Imagine an American HHS Secretary begging a Mozambican health minister for access to the country’s genetic databases. Those geopoliticians will regret missing our session!

WHO estimates 15 million death toll due to COVID-19; The latest health stories from around the world

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WHO, COVID-19

The World Health Organization (WHO) has estimated that nearly 15 million people—about one in every 500 globally—died from causes related to the coronavirus pandemic in 2020 and 2021 (the first two years of the pandemic), putting the toll from COVID-19 at nearly three times the number that had been officially recorded by countries. India suffered the highest toll of any country in the world, according to the report released Thursday, but most of the deaths have gone unrecorded. The 4.7 million people estimated to have died in India by the end of last year, according to WHO calculations, was nearly 10 times the official tally at that time of 481,000 deaths. India’s count has risen to about 524,000 since then. The report, which was compiled by scientists from around the world, has sparked fierce resistance from India, where government officials have denounced the health agency’s methodology and objected to the release of the report.

https://www.wsj.com/articles/who-says-15-million-have-died-from-covid-19-pandemic-11651755496

WHO revelations have prompted The Economist to reiterate its own model projects made last October that COVID caused about 18 m excess in the same period.

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The US Food and Drug Administration (FDA) has limited the use of the COVID-19 vaccine from Johnson & Johnson after reviewing the risk of life-threatening blood clots. The agency said Thursday that the J&J shot’s authorisation was now only for adults for whom other shots aren’t available or medically appropriate, or who won’t take another vaccine. The FDA said it was making the move after confirming a total of 60 cases, including nine deaths, of the clotting condition known as thrombosis with thrombocytopenia syndrome, or TTS, among the millions of people who got the J&J shot.

https://www.wsj.com/articles/fda-limits-authorized-use-of-j-j-s-COVID-19-vaccine-11651788829

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Africa’s top public health body urged all those purchasing COVID-19 vaccines for the continent to place orders with South Africa’s Aspen Pharmacare, saying the market was key to developing vaccine manufacturing on the continent. The Africa Centre for Disease Control and Prevention (CDC) said it was doing everything it could behind the scenes to prevent a situation where Aspen closes its facility due to a lack of orders.

https://www.reuters.com/business/healthcare-pharmaceuticals/africa-cdc-urges-COVID-19-vaccine-buyers-order-safricas-aspen-2022-05-05/

Meanwhile Aspen Pharmacare said it would switch about half of its COVID-19 vaccine production capacity onto other products if demand doesn’t pick up within six weeks, its CEO warned, as South Africa’s president and health officials urged more Africans to take the shots. Aspen completed a deal in March to package, sell and distribute Johnson & Johnson’s COVID-19 vaccine in what was considered a game-changing moment for an under-vaccinated continent frustrated by sluggish Western handouts.

https://www.reuters.com/business/healthcare-pharmaceuticals/safricas-aspen-slash-COVID-vaccine-capacity-within-6-weeks-if-no-orders-ceo-2022-05-05/

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Bill Gates’s career-switch from entrepreneur and philanthropist to crusading author coming along developing nicely. It is just over a year since he published “How to Avoid a Climate Disaster”. Now Gates is back with “How to Prevent the Next Pandemic”. The Economist’s podcast on science and technology features an interview with Mr Gates on his views on stopping new pathogens from becoming health emergencies. The weekly edition goes on to explain why his proposals are worth exploring. 

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From the earliest days of the pandemic, scientists have hoped that interferons, a family of potent proteins that are the body’s own first line of defence against viruses, could become weapons against SARS-CoV-2. Because the virus effectively blunts the interferon response, researchers thought providing extra interferons could counter it. But for 2 years, interferons have disappointed in trials in hospitalized patients.

Now, a strikingly positive result from a large trial of non-hospitalized, high-risk people in Brazil has revived hopes. In a study of more than 1,900 people, those who received a single shot of a drug called peginterferon lambda within 7 days of developing symptoms of COVID-19 were half as likely to be hospitalized or to endure lengthy emergency room visits as those who received a placebo. The effect, which the trial’s sponsor, Eiger BioPharmaceuticals, reported in a press release, was seen across many SARS-CoV-2 variants, including Omicron.

Eiger said  it plans to apply for an emergency use authorization for the shot from the FDA by 30 June. It plans to make full data from the trial available at that time.

Earlier a much smaller trial in younger outpatients with early, uncomplicated SARS-CoV-2 infection found the Eiger injection did not reduce symptom duration or the time it took people to clear the virus. The scientists who led that trial agree. “Until we see a peer-reviewed publication, I am cautious re[garding] press release[s] from companies,” Upinder Singh, an infectious diseases physician at the Stanford University School of Medicine, said in an email.

www.science.org/content/article/interferon-therapy-shows-striking-results-against-COVID-19

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Following a meeting with the Chinese Olympic Committee, the Olympic Council of Asia said that the 19th Asian Games, set to be held in the Chinese city of Hangzhou in September, would be postponed and new dates announced “in the near future”. China continues to battle a spread of COVID-19 cases.

The Asian Youth Games, also to be held in China in December in Shantou, will be cancelled as the games had been postponed once last year.

Another major event that China was to host this summer, the World University Games, has also been postponed. The International University Sports Federation (FISU) said the games, to be held in Chengdu, would likely be held next year.

The postponements underlined the costs of China’s “zero-COVID” strategy. The cities had already prepared venues for the events and extensive arrangements to welcome athletes from around the world.

While the rest of the world has opened up and returned to some form of normalcy, China remains the only country still closed to the world and following a strict “zero-COVID” approach. China still bars most international travellers.

That approach led to a harsh lockdown of Shanghai for more than one month, with many of the city’s 26 million residents still under some form of restrictions. Beijing, meanwhile, has carried out repeated mass testing and closed schools as it deals with cases.

Amid growing criticism of the stringent measures, the ruling Communist Party’s top leadership met on Thursday and issued a strong signal to reaffirm that the current policy would remain in place.

A meeting of the Politburo Standing Committee chaired by President Xi Jinping said the “zero-COVID” approach would continue and warned those who questioned it, saying that the Communist Party would “resolutely oppose” and “resolutely struggle” against those who doubted the current policy.

www.thehindu.com/sport/other-sports/asian-games-2022-in-china-postponed-amid-COVID-resurgence/article65387663.ece?

Meanwhile COVID-hit Beijing returned to work Thursday after a subdued five-day Labour Day break. The holiday was devoid of the usual trips across the country or lavish family dinners, as China pledged to fight any criticism of its uncompromising “zero-COVID” policy. The long break is usually one of the most lucrative times of the year for restaurants, hotels and other businesses in China. This year, travellers spent 43% less than in 2021, data showed on Thursday

https://www.reuters.com/world/china/beijing-returns-work-after-5-day-break-high-alert-COVID-2022-05-05/

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www.nytimes.com/2022/05/04/health/COVID-variants-gamma-iota-mu.html?

In early 2021, scientists in Colombia discovered a worrisome new coronavirus variant. This variant, eventually known as Mu, had several troubling mutations that experts believed could help it evade the immune system’s defences.

Over the following months, Mu spread swiftly in Colombia, fuelling a new surge of COVID-19 cases. By the end of August, it had been detected in dozens of countries, and the World Health Organization had designated it a “variant of interest.”

And then it fizzled out. Today, the variant has all but vanished.

For every Delta or Omicron there is a Gamma, Iota or Mu, variants that drove local surges but never swept to global dominance. And while understanding Omicron remains a critical public health priority, there are lessons to be learned from these lesser lineages, experts say.

Studies of the also-rans have shed light on surveillance gaps and policy blunders — providing more evidence that America’s international travel bans were not effective — and on what makes the virus successful, suggesting that in the early phase of the pandemic, transmissibility was more important than immune evasion.

The research also highlights how much context matters; variants that make an impact in some places never gain a foothold in others. As a result, predicting which variants will surge to dominance is difficult, and staying on top of future variants and pathogens will require comprehensive, nearly real-time surveillance.

The coronavirus is constantly changing, and most new variants never get noticed or named. But others raise alarms, either because they quickly become more common or because their genomes look ominous.

Both were true of Mu as it spread in Colombia. Several of the mutations in its spike protein had been documented in other immune-evasive variants, including Beta and Gamma.

In the new study, which has not yet been published in a scientific journal, scientists compared Mu’s biological characteristics to those of Alpha, Beta, Delta, Gamma and the original virus. Mu did not replicate faster than any other variant, they found, but it was the most immune-evasive of the bunch — more resistant to antibodies than any known variant besides Omicron.

By analysing the genomic sequences of Mu samples collected from all over the world, the researchers reconstructed the variant’s spread. They concluded that Mu had likely emerged in South America in mid-2020. It then circulated for months before it was detected.

Mu presented another challenge, too. It happened to have a type of mutation, known as a frameshift mutation, that was rare in coronavirus samples.

That complication created delays in the public sharing of Mu sequences. The time that elapsed between when a virus sample was collected from a patient and when it was made publicly available on GISAID was consistently longer for Mu cases than for Delta cases, the researchers found.

Combine these surveillance gaps with Mu’s immune evasiveness and the variant seemed poised to take off. But that is not what happened. Instead, Mu radiated from South and Central America to other continents but did not circulate widely once it got there, the scientists found.

That was likely because Mu found itself competing with an even more formidable variant: Delta. Delta was not as skilled at dodging antibodies as Mu, but it was more transmissible. So, in the end, Delta spread more widely.

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Lalita Panicker is Consulting Editor, Views, Hindustan Times, New Delhi

Could climate change aid the spread of viruses? The latest health stories from around the world

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Climate crisis concept. Copyright: sangoiri / 123RF Stock Photo. Climate emergency concept. Torrential rainfall concept.
Image credit: sangoiri / 123RF Stock Photo

Earth’s warming climate is expected to change the habitat of many animal species, which a new modelling study predicts may spell trouble: Species on the move will mingle with many others they have never encountered before, allowing the various animals to exchange viruses. That could spark new disease outbreaks in many wildlife populations—and in humans as well, according to a report www.science.org/content/article/animal-melting-pot-created-climate-change-could-lead-new-disease-outbreaks?

By 2070, assuming the most conservative warming scenario, there will be at least 15,000 new cross-species transmissions involving more than 3000 mammalian species, according to a modelling team led by Colin Carlson, a global change biologist at Georgetown University. “Most of this pattern has probably been set in motion with the 1° of warming we’ve already experienced,” says Carlson, whose study appears online in Nature today.

The modelers calculate there are some 21 million possible pairings of mammalian species, and only 7% of those duos currently share a geographic range, which means there’s a tremendous opportunity for new encounters. “Most species on Earth haven’t met each other yet,” Carlson says.

For a concrete example, the team did a case study of Zaire ebolavirus, which they predict has 13 possible mammalian hosts based on known susceptibility factors. Adding in dispersal limitations of species, they estimate that the least dramatic climate change scenario could cause the virus to be involved in more than 2,000 first encounters between two species, of which nearly 100 might lead to a jump from one species to the other. Those leaps could cause deaths in some of these species but could also lead to Ebola infections in humans in the Horn of Africa, where the disease has never been seen.

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A COVID-19 vaccine named Corbevax looked like a triumph for India’s burgeoning drug industry. Because its U.S. developers hadn’t claimed a patent on it, an Indian manufacturer named Biological E was able to sell the two-dose protein-based vaccine to the government at the extraordinarily low price of 145 rupees ($1.90) per dose. In March, the country began to give the shots to 12- to 14-year-olds, a group for which India did not yet have a licensed COVID-19 vaccine.

But the celebration was quickly drowned out by questions over whether India’s drug regulator, the Central Drugs Standard Control Organization (CDSCO), had properly vetted the vaccine. www.science.org/content/article/india-s-speedy-approvals-covid-19-vaccines-come-under-fire?

In February, CDSCO had authorized the use of Corbevax for adolescents ages 12 to 18. But within weeks, the Indian media outlet The Wire Science revealed that the National Technical Advisory Group on Immunisation (NTAGI), an expert group that advises the health ministry on which vaccines to add to the national immunization program, had questioned whether Biological E had shown the vaccine is effective. In adolescents, who are at a lower risk of severe COVID-19, the benefits of a vaccine should be beyond any doubt. 

Other CDSCO approvals of COVID-19 vaccines have raised questions as well, both from NTAGI and independent experts. The agency has used “suboptimal” standards on several occasions, says Vineeta Bal, an immunologist at India’s National Institute of Immunology. That has led some scientists to ask whether the agency has the capabilities—and is independent enough—to oversee the quality of medicines for India’s 1.4 billion people. The implications go beyond India, because the country is a major global medicine supplier. The World Health Organization has “prequalified” 54 vaccines produced in India for use elsewhere, and WHO relies on CDSCO to oversee the manufacturers.

CDSCO didn’t respond to questions from Science about the criticism. 

CDSCO has a decent reputation: Based on an extensive assessment, WHO concluded in 2017 that it was a “functional” drug regulator, a distinction only 30% of its counterparts around the world enjoy. (It ranks a step below 11 agencies WHO credits with a “high level of performance,” however, including the U.S. Food and Drug Administration and the European Medicines Agency.)

But the pandemic has been challenging for CDSCO, says Gagandeep Kang, a public health microbiologist at Christian Medical College, Vellore. For the first time, Indian manufacturers developed new vaccines rather than me-too versions of shots approved elsewhere, and the agency lacked some types of expertise, Kang says, such as the ability to reanalyse data from key studies. Others suspect CDSCO’s decisions have been skewed by political pressure to quickly approve made-in-India vaccines, which have been a point of pride for the ruling Bharatiya Janata Party. 

In January 2021, for example, the agency greenlit Covaxin, an inactivated-virus vaccine produced by Bharat Biotech, without data from large-scale efficacy trials—only phase 2 data about the immune response generated by the vaccine. By the time the company published data showing 78% efficacy against symptomatic COVID-19, 6 months later, millions of Indians had already received the shot.

NTAGI also differed with CDSCO’s assessment when the regulator approved a COVID-19 vaccine named ZyCoV-D for use in both adults and adolescents in August 2021. Produced by Zydus Cadila in Gujarat state, ZyCoV-D is the first DNA vaccine approved by any country for use in humans. CDSCO based its decision on results of a trial in about 28,000 participants over 12 years of age, which found the vaccine 67% efficacious at preventing symptomatic COVID-19.

In March, CDSCO’s reputation took another hit when a WHO inspection of the Covaxin manufacturing facility in Hyderabad found quality control deficiencies, whose nature WHO has not disclosed. WHO recommended that member countries stop using the vaccine, and Bharat voluntarily halted exports. But the company has downplayed the problems and says it will keep selling Covaxin in India. CDSCO did not respond to questions from Science about the problems or why it failed to spot them. 

Last month’s approval of Corbevax—which by now has been given to 30 million adolescents—raised more questions. CDSCO authorized the vaccine for 12- to 18-year-olds based on interim data from a 312-participant study that showed the vaccine triggered a rise in neutralizing antibodies. But NTAGI wasn’t convinced the vaccine was entirely responsible for the rise. Data from the unvaccinated placebo group could have shed light on whether COVID-19 infections were also contributing, but as a preprint posted on 26 April shows, the trial did not assess antibodies in the placebo group. Biological E did not respond to a question about the data.

Since then Botswana has also licensed Corbevax. And on 21 April, an expert committee advising CDSCO recommended the shot’s approval for 5- to 12-year-olds in India.

Corbevax co-developer Peter Hotez, who leads the Texas Children’s Hospital Center for Vaccine Development, says Indian companies have a strong track record for producing WHO-prequalified vaccines. “I’m not aware they apply lower bars and standards,” Hotez says. “It would be unfair to think so and in fact it reflects colonial attitudes.” 

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A study by researchers from the Indian Institute of Science, Bengaluru has revealed that a drug used in the treatment of Asthma can reduce SARS-CoV-2, the virus that causes Covid-19, from replicating in human immune cells. www.indiatoday.in/science/story/asthma-drug-blocks-coronavirus-from-replicating-finds-study-1941668-2022-04-25

Montelukast has been around for more than 20 years and was approved by the US Food and Drug Administration (FDA) to reduce inflammation caused by conditions like asthma, hay fever and hives. It has now been found effective against Covid-19.

Researchers at the IISc found that the drug binds strongly to one end (‘C-terminal’) of a SARS-CoV-2 protein called Nsp1, which is one of the first viral proteins unleashed inside human cells. This protein can bind to ribosomes the protein-making machinery inside our immune cells and shut down the synthesis of vital proteins required by the immune system, thereby weakening it.

The study published in the journal eLife states that “montelukast sodium hydrate can be used as a lead molecule to design potent inhibitors to help combat SARS-CoV-2 infection.”

Tanweer Hussain, assistant professor in the department of Molecular Reproduction, Development and Genetics (MRDG), IISc, and senior author of the study explains that the mutation rate in this protein, especially the C-terminal region, is very low compared to the rest of the viral protein and since Nsp1 is likely to remain largely unchanged in any variants of the virus that emerge, drugs targeting this region are expected to work against all such variants.

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An overall ninefold increase in COVID-19 antibody levels can be seen with a longer interval between first and second doses of the Pfizer/BioNTech (BNT162b2) vaccine in people without prior infection, according to data from the UK government’s SIREN (SARS-CoV-2 Immunity and Reinfection Evaluation) study. www.medscape.com/viewarticle/972647?uac=398271FG&faf=1&sso=true&impID=4200673&src=mkm_ret_220501_mscpmrk_covid-ous_int

This interval-dependent antibody level varied by age, with those aged 45-54 years showing an 11-fold increase with a longer dosing interval (greater than 10 weeks vs 2-4 weeks). People younger than age 25 years showed a 13-fold increase with the longer interval, but participant numbers were low in this sub-group.

The work is the latest analysis from SIREN, which measured antibody levels in the blood from nearly 6000 healthcare workers from across the UK. Study lead Ashley Otter,  technical lead for SIREN serology at the UK Health Security Agency (UKHSA), will present the work on Tuesday at this year’s European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) in Lisbon.

The study, which appeared in the March issue of the New England Journal of Medicine, also found that after the second dose of vaccine, there was about a 2.5-fold difference. 

Following the first dose only, antibody levels were up to 10 times higher in participants who were previously infected compared with infection-naive individuals. This effect lasted up to 8 months and then began to plateau.

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Lalita Panicker, Consulting Editor, Views, Hindustan Times, New Delhi

A third of the world have not had a single COVID-19 vaccination; the latest health stories from around the world

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Vials containing the Moderna COVID-19 vaccine sit on a table in preparation for vaccinations at Kadena Air Base, Japan, Jan. 4, 2021. As part of the DoD strategy for prioritizing, distributing and administering the COVID-19 vaccine, those providing direct medical care and emergency services will be prioritized to receive the vaccine at units based in Japan, including Kadena AB. (U.S. Air Force photo by Airman 1st Class Anna Nolte) Photographer: Airman 1st Class Anna NoltePost-production: Zacharie Grossen, Public domain, via Wikimedia Commons. Moderna offered indemnity concept.
Photographer: Airman 1st Class Anna NoltePost-production: Zacharie Grossen, Public domain, via Wikimedia Commons

Sixteen months since the COVID-19 vaccination drive began and a third of the world’s population hasn’t yet received a single dose of the vaccine. A shocking 83 percent of all Africans are in the same boat, said the head of the World Health Organization (WHO) on 30 March.

Meanwhile last week the total number of COVID-19 cases worldwide had risen to 509,418,071 and the total deaths 6,217,596

The total vaccine doses administered stood at 11,236,923,250.

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Despite its low vaccination rate, Africa is experiencing its longest-running decline in COVID-19 infections since the onset of the pandemic.

This is according to the WHO (Africa), which said weekly cases have fallen for the past 16 weeks, while deaths have dropped for the past eight.

Infections– largely due to the Omicron-driven fourth pandemic wave – have tanked from a peak of over 308 000 cases weekly at the start of the year to less than 20 000 in the week ending on April 10.

This low level of infection has not been seen since April 2020 in the early stages of the pandemic in Africa.

https://www.iol.co.za/capetimes/news/weekly-COVID-cases-continue-to-fall-in-africa-843641f6-c571-43d1-8dd0-3d0704b7ce3c

And in sharp contrast, the world’s tightest lockdown in China’s largest city has failed to contain a COVID-19 spurt. With the lockdown into its fourth week, Shanghai had 51 deaths on Sunday, not alarming by many standards elsewhere but anathema to the “zero COVID” fanatics running the country.

Chinese internet users rallied to outwit government censors on a video documenting weeks of lockdown in Shanghai, flooding social media feeds as frustration continued to escalate over strict COVID-zero rules. The six-minute video titled “The Sound of April” was posted on Friday and soon got censored as it went viral. Chinese WeChat users then uploaded the film from different accounts and in various forms including upside-down and mirrored versions until late night, as newly-uploaded clips were also removed. The film, on a slowly-moving frame of overhead shots of the city in black-and-white, spliced in sound clips from government press briefings, voice call recordings seeking medical help and information transparency, hungry and frustrated residents chanting in unison for government rations, and chats between neighbours and ordinary people helping each other out.

https://www.bloomberg.com/news/articles/2022-04-23/china-web-users-race-to-post-censored-video-on-lockdown-troubles

Meanwhile, onward to China’s capital Beijing where the “zero zealots” have begun frantically locking down suburban clusters even as cases mount.

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A Japanese Health Ministry committee said last Monday that it has approved Novavax Inc’s COVID-19 vaccine, setting the stage for full approval of the country’s fourth shot for the coronavirus, according to a Reuters report.

The Japanese government has agreed to purchase 150 million doses of Novavax’s recombinant-protein vaccine, which is to be manufactured domestically by Takeda Pharmaceutical Co.

Most of Japan’s COVID vaccinations have been carried out with the mRNA types made by Pfizer Inc and Moderna Inc. Astrazeneca Plc’s shot has also been approved, but most domestically produced supplies have not been used in Japan and instead donated overseas.

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The rapid development of vaccines against COVID-19 has been a triumph of science, with more than half the world’s population inoculated since vaccines first became available in late 2020. But that triumph has not been shared equally around the world, with only 15 percent of people in low-income countries receiving even a single vaccine dose by late March 2022. www.medscape.com/viewarticle/972385?uac=398271FG&faf=1&sso=true&impID=4182547&src=mkm_ret_220424_mscpmrk_COVID-ous_int)

One reason for this imbalance is that the mRNA vaccines that have been so successful in wealthy nations are novel, expensive and technologically challenging to produce. Only a few companies have the expertise to manufacture them and high-income countries have hoarded more than 70 percent of doses.

Efforts to ramp up production of mRNA vaccines in middle- and low-income countries are now underway, including in some African countries. But mRNA is fragile and tricky to handle, requiring some vaccines to be stored at ultra-cold temperatures. This adds to the complexity of vaccine manufacture and to the challenges in distribution in remote areas. Vaccines that use genetically modified viruses to introduce coronavirus proteins, like the Johnson & Johnson vaccine, are also relatively new and technically challenging to produce.

A better option is to turn to more traditional vaccine technologies that don’t require as much new infrastructure, says Maria Elena Bottazzi, a vaccine researcher at Baylor College of Medicine in Houston. Bottazzi co-authored a look at Covid-19 vaccines that use more accessible technologies in the 2022 Annual Review of Medicine. Such vaccines deliver whole, inactivated viruses or fragments of viral protein to stimulate the immune system to produce antibodies, and they can be more than 90 percent effective at preventing disease, just like the mRNA vaccines.

Unlike mRNA technology, factories already exist in many middle- and low-income countries to produce these older types of vaccines, which include the familiar hepatitis A and B and polio vaccines. Such shots also tend to cost less than the new mRNA vaccines: a few dollars a dose, compared to more than $10 per dose. In partnership with the Indian company Biological E, Bottazzi and her Baylor colleague and co-author Peter Hotez have developed one such COVID-19 vaccine, Corbevax, using protein fragments, which is now licensed for use in India and Botswana.

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A long-delayed assessment of the health effects of formaldehyde has concluded that the widely used chemical poses a greater cancer risk than had been estimated, which could lead to greater regulation. Most people are exposed to formaldehyde in airborne emissions from the glue in treated plywood and particle board used in buildings. A draft assessment 12 years ago by the US Environmental Protection Agency (EPA) that linked formaldehyde exposure to an increased risk of leukaemia and other cancers drew objections from members of the US Congress and industry representatives, who maintain that products containing formaldehyde are safe. The new draft, released last week, finds a higher risk of myeloid leukaemia. In an unusual step, it will be reviewed by the National Academies of Sciences, Engineering, and Medicine, which 11 years ago criticized EPA for not clearly presenting its methods in the earlier assessment. If the agency formally classifies formaldehyde as a carcinogen, EPA could tighten restrictions on its use under the Toxic Substances Control Act.

www.science.org/content/article/news-glance-nyet-russia-oyster-restoration-and-harassment-field-sites?utm_source=sfmc

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Doctors and scientists have developed an Artificial Intelligence (AI) tool that can accurately predict how likely tumours are to grow back in cancer patients after they have undergone treatment. www.theguardian.com/society/2022/apr/23/cancer-ai-tool-predicts-tumour-regrowth?

The breakthrough, described as “exciting” by clinical oncologists, could revolutionise the surveillance of patients. While treatment advances in recent years have boosted survival chances, there remains a risk that the disease might come back.

Monitoring patients after treatment is vital to ensuring any cancer recurrence is acted on urgently. Currently, however, doctors tend to have to rely on traditional methods, including ones focused on the original amount and spread of cancer, to predict how a patient might fare in future.

Now a world-first study by the Royal Marsden NHS Foundation Trust, the Institute of Cancer Research, London, and Imperial College London has identified a model using machine-learning – a type of AI – that can predict the risk of cancer coming back, and do it better than existing methods.

“This is an important step forward in being able to use AI to understand which patients are at highest risk of cancer recurrence, and to detect this relapse sooner so that re-treatment can be more effective,” said Dr Richard Lee, a consultant physician in respiratory medicine and early diagnosis at the Royal Marsden NHS Foundation Trust.

Lee, the chief investigator of the OCTAPUS-AI study, told the Guardian it could prove vital in not only improving outcomes for cancer patients, but alleviating their fears, with relapse “a key source of anxiety” for many. “We hope to push boundaries to improve the care of cancer patients, to help them live longer, and reduce the impact the disease has on their lives.”

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Lalita Panicker is Consulting Editor, Views, Hindustan Times, New Delhi