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US FDA announces autumn COVID-19 strategy; The latest health stories from around the world

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

The U.S. Food and Drug Administration (FDA) last week endorsed a strategy for a COVID-19 vaccine to be used this autumn that favours a composition different from one recently recommended by an agency advisory committee. The continuing evolution of SARS-CoV-2 makes choosing the most effective vaccine challenging. www.science.org/content/article/news-glance-saving-endangered-leopard-restoring-europe-s-habitats-and-assessing?

This month, the panel of outside scientists suggested the FDA greenlight a vaccine design matched to the variant JN.1; most current infections stem from viruses descended from it. JN.1 is also the version the World Health Organization recommended for vaccines in April, when it was more prevalent. But a drawback of this approach is that JN.1 has been overtaken by two offspring, KP.2 and KP.3, implicated in up to 50% of current U.S. cases. On 14 June, FDA announced it will permit a vaccine aimed at JN.1 but favours targeting KP.2 “if feasible”—a suggestion that vaccine makers Pfizer and Moderna will likely follow. Another maker, Novavax, is already producing the JN.1 vaccine; the company began earlier because its vaccine takes longer to make.

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In 2020 and 2021, the U.S. military ran a secret campaign to discourage people in the Philippines and Muslim-majority countries from using a COVID-19 vaccine made in China, Reuters reported in an investigation published last week. The strategy may have caused preventable deaths. U.S. military officials told the news service the campaign was meant to counter China’s growing political influence and push back against online claims it made that SARS-CoV-2 originated in the U.S. https://www.science.org/content/article/news-glance-saving-endangered-leopard-restoring-europe-s-habitats-and-assessing?

Public health officials blasted the U.S. effort, in which a Department of Defense unit used phony online accounts to post messages criticising China’s Sinovac vaccine—the first against COVID-19 to become available in the Philippines after the U.S. and other wealthy countries scooped up doses of other vaccine types. Studies indicated Sinovac was less effective than other vaccines, but the World Health Organization endorsed it. The U.S. messages targeted at Muslims suggested Sinovac contained a pork derivative, which its maker has denied.

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For several decades, evidence has accumulated that animals turn to medicinal plants to relieve their ailments. Chimpanzees (and some other species) swallow leaves to mechanically clear the gut of parasites. Chimps also rely on the ingested pith of an African relative of the daisy, Vernonia amygdalina, to rid themselves of intestinal worms. www.science.org/content/article/chimps-use-more-plant-medicines-any-other-animal?

Dolphins rub against antibacterial corals and sponges to treat skin infections. And recently, a male Sumatran orangutan was observed chewing the leaves of Fibraurea tinctoria, a South Asian plant with antibacterial and anti-inflammatory properties, and dabbing the juice onto a wound.

These instances of animals playing doctor with therapeutic plants have typically been identified one by one. Last Thursday, in PLOS ONE, a multinational team proposed adding 17 samples from 13 plant species to the chimpanzee pharmacopeia.

“The paper provides important new findings about self-medication behaviour in wild chimpanzees,” a topic that’s still relatively unknown, says Isabelle Laumer, a cognitive biologist at the Max Planck Institute of Animal Behaviour and lead author on the orangutan self-medication paper who was not involved in the new chimp research.

Observers with the team behind the paper spent 4 months with each of two chimp communities habituated to human observers in Uganda’s Budongo Forest. The researchers supplemented their own observations with historical data.

From the 170 chimps in the two communities, the observers zeroed in on 51 individuals suffering bacterial infections and inflammation as indicated by abnormal urine composition, diarrhoea, traces of parasites, or apparent wounds. For 10 hours a day they followed the sick chimps through the forest, noting which plants they ate and when, and watching in particular to see whether the animals went out of their way to find and consume plants not part of their usual diet.

In one example, researchers observed an individual suffering from diarrhoea very briefly venture outside the group’s safe home territory to eat a small amount of dead wood from Alstonia boonei, a tree in the dogbane family. Chimps rarely eat dead wood, which is not nutritious for them, the team says.

A different chimp with a hand wound was seen gobbling leaves of Christella parasitica, a type of fern, while nearby companions ate other plants. Fern eating had been documented only once before in this community.

The team—made up of researchers from the University of Oxford and groups at other institutions in Europe, Japan, and Uganda—tested samples of all the plants eaten by sick chimps for antibiotic and anti-inflammatory properties. They also reviewed the scientific literature for reports of use in local traditional medicines. A. boonei, the dogbane tree, exhibited antibacterial and anti-inflammatory activity in vitro. Traditional medicine practitioners in Africa use the plant to treat bacterial infections, gastro-intestinal issues, snakebites, and asthma. The fern proved to have anti-inflammatory properties as well, which might have benefited the chimp’s hand injury, but humans haven’t been reported to use it for healing.

In all, 11 of the 13 plants the team investigated are used in local traditional remedies, boosting the evidence that chimps use plants to help heal, researchers say. 

For all 51 sick chimps, the self-medication appeared to work. “Every individual recovered, and relatively quickly,” says Oxford primatologist Elodie Freymann, the study’s lead author, though she cautions that she can’t be sure their healing was due to the plants.

The new plant candidates “need to be looked at in more detail,” acknowledges Michael Huffman, a primatologist at Nagasaki University and a co-author of the study. But the evidence to date suggests the ill chimps select plants that could alleviate their symptoms, he says.

Researchers aren’t sure how animals learn to self-medicate. Huffman says some research suggests illness triggers an instinctual craving for bitter-tasting foods, which often have antiparasitic or antibiotic properties. But John Arnason, a Phyto chemist and ethnopharmacology expert at the University of Ottawa, thinks “non-human primates may have used the same trial and observation methods humans have used to find effective medicines, then passed on the information to their offspring.”

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The African Vaccine Manufacturing Accelerator “will be an essential step towards a genuine African vaccine market,” French President Emmanuel Macron said at the opening of the summit in Paris.

Three quarters of this funding will come from Europe, Macron told the summit, which was also attended by leaders from Botswana, Rwanda, Senegal, Ghana, as well as visiting ministers, health groups and pharmaceutical firms. www.france24.com/en/africa/20240620-world-leaders-announce-1-2-billion-to-produce-vaccines-in-africa-at-paris-summit-pharmaceutical-industry-african-union-cholera

Germany will contribute $318 million to the scheme, German Chancellor Olaf Scholz said in a video message.

France put in $100 million and the UK $60 million, while other donors include the U.S, Canada, Norway, Japan and the Gates Foundation.

The scheme “could become a catalyst for promoting the pharmaceutical industry in Africa and fostering collaboration between member states”, African Union commission chief Moussa Faki Mahamat told the summit.

Africa imports “99 percent of its vaccines at an exorbitant cost”, he added.

The Covid-19 pandemic shone a light on the unequal global distribution of vaccines, as wealthy countries home to big pharma firms snapped up most doses, leaving Africa far behind.

The new scheme aims to move vaccine production to Africa to give the continent more sovereignty—and avoid history repeating.

“When the next pandemic hits, even if our leaders in the rich Western countries are angels, the pressure to hold on to your own vaccines, for your own people, is always going to be irresistible,” British Foreign Secretary David Cameron told the summit.

A recent resurgence of cholera in many parts of Africa has highlighted the need for more local vaccine producers. Only one firm in the world—South Korea’s EuBiologics—makes the cheap and effective vaccine doses for the deadly disease.

Macron called for cholera to be “consigned to the past”, adding that outbreaks were now affecting “half of Africa”.

He announced a production chain for cholera vaccines to be launched in Africa by the South African biopharmaceutical firm Biovac.

The Gavi vaccine alliance, which helps distribute jabs for more than 20 different diseases to poorer countries, was one of the organisers of last Thursday’s Global Forum for Vaccine Sovereignty and Innovation.

At the forum, Gavi announced it is seeking to raise $9 billion to fund its vaccine programmes.

The U.S. will contribute $1.58 billion to the Gavi effort, first lady Jill Biden said in a video message, with more commitments expected later.

Only two percent of the vaccines administered in Africa are made on the continent. The African Union aims to raise this figure to 60 percent by 2040.

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South Africa’s public health care system has run out of the human insulin pens that it provides to people with diabetes, as the pharmaceutical industry shifts production priorities to blockbuster weight-loss drugs that use a similar device for delivery. www.nytimes.com/2024/06/19/health/insulin-pens-south-africa-ozempic-wegovy.html

Novo Nordisk, the company that has supplied South Africa with human insulin in pens for a decade, opted not to renew its contract, which expired last month. No other company has bid on the contract — to supply 14 million pens for the next three years, at about $2 per pen.

“Current manufacturing capacity limitations mean that patients in some countries, including South Africa, may have limited access to our human insulins in pens,” said Ambre James-Brown, a spokeswoman for Novo Nordisk. The company did not reply to questions about which other countries are affected.

Novo Nordisk’s drugs Ozempic and Wegovy, which are widely prescribed in the U.S. for weight loss, are sold in single-use pens produced by many of the same contracted manufacturers who make the multidose insulin pens. A month’s supply of Ozempic in the U.S costs about $1,000, far more than insulin.

Novo Nordisk dominates the global market for insulin in pens and has supplied South Africa since 2014. Eli Lilly, the other major producer, has indicated in recent months that it is struggling to keep up with the significant demand for its weight-loss drug Zepbound.

“This is because of the global demand for Ozempic and these drugs,” said Khadija Jamaloodien, the director of sector-wide procurement for South Africa’s health service. “They’re shifting the focus on the more profitable line.”

Novo Nordisk is continuing to supply human insulin in vials to South Africa, where more than four million people live with diabetes, but pens are considered much easier to use and more precise.

A pen can be set with a dial to dispense a given amount of insulin, and its needle tip can be quickly jabbed into the skin. Insulin from a vial has to be drawn out into a syringe with the patient or a caregiver confirming the dose, and then injecting it.

The vial system was phased out for most South Africans in 2014. But recently, South Africa’s National Department of Health instructed clinicians that they should teach patients how to use vials and syringes of insulin instead of pens.

Muhammed Adnan Malek, 19, a teachers’ college student in the town of Zeeland in South Africa’s northwest, has used insulin pens from the public health system to treat his Type 1 diabetes for nine years.

“I’ve never used it in syringes, so when I heard this news, I asked an 80-year-old I know with diabetes what it’s like, and he said it’s very difficult because it’s hard to give the exact dose,” Mr. Malek said. “With insulin, if you’re a unit higher or lower it really has an effect. If you overdose, you go into hypoglycaemia and it can lead to coma and death.”

Ms. Jamaloodien’s office has instructed clinicians to reserve the remaining small stock of pens for people who will struggle most with using vials and syringes — small children, the elderly and visually impaired people.

Ms. Jamaloodien of the South African health service said that the company told the government only that there would be “supply constraint” but not that it was exiting completely. That, she said, did not become clear until the contracting process ended in January. After that, her department was slow to issue a new tender to try to find another supplier, because of staffing constraints, and it has been scrambling to try to fill the gap, she said.

Novo Nordisk has an insulin access policy, under which it supplies insulin for $3 a vial to low-and middle-income countries, and for $2 a vial to humanitarian groups such as Médécins Sans Frontières, or MSF. The company signed an agreement last year with the South African drugmaker Aspen Pharmacare to manufacture human insulin there, aiming to produce 60 million vials by 2026.

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