Article by Lalita Panicker, Consulting Editor, Views and Editor, Insight, Hindustan Times, New Delhi
On 3 May, the U.S. Department of Agriculture (USDA) issued a “request for information” from companies that have the capability to develop and produce cow vaccines against H5N1. Jamie Jonker, chief science officer at the National Milk Producers Federation, says he knows of up to 10 companies that have “expressed interest.” The American Association of Bovine Practitioners (AABP), a group of veterinarians, 2 weeks ago held closed-door presentations from several potential vaccine makers. www.science.org/content/article/companies-start-work-bird-flu-vaccines-cows-despite-major-hurdles?
“If something was to be made available and shown to be efficacious and safe, I think there would be wide use of it,” Jonker says. The outbreak has already been confirmed in nine states, and the United States has 13 million mature dairy cattle and young stock.
But companies must weigh several factors before jumping in. Strict rules around research with H5N1 and other highly pathogenic type A avian influenza viruses slow down the development of vaccines. The market could vanish if the outbreak peters out or is brought under control by ramping up biosecurity efforts, such as improving hygiene in dairy parlours. Also unclear is whether USDA will even allow the use of vaccination, which might complicate exportation of dairy products.
Several companies declined to discuss their plans with Science, but a few confirmed they are already making candidate vaccines. Ceva Animal Health, a French company with North American headquarters in Kansas, has sold vaccines that protect chickens against H5N1 for 15 years and recently introduced a new one that’s used in ducks in France. Unlike earlier products tailored for chickens, this vaccine is “species agnostic,” says Ceva virologist John El-Attrache. Based on RNA coding for the hemagglutinin gene—the “H” in H5N1—of the 2.3.4.4b variant devastating wild birds and poultry, it has protected different poultry species and even pelicans in zoos. Studies to find out whether it works in cows as well will start “within weeks,” El-Attrache says. If so, Ceva could produce large quantities of the vaccine quickly.
Medgene Labs in Brookings, South Dakota, already makes a vaccine to protect cattle from type D influenza, a less menacing strain discovered in cows in 2013, and could also start to produce an H5N1 vaccine “overnight,” says co-founder Alan Young, an immunologist at South Dakota State University. Medgene uses baculovirus, which normally infects insects, as a “platform” into which the company can “plug and play” different influenza genes to produce vaccines against specific viruses.
Testing the vaccines won’t be easy, however. The U.S. government classifies H5N1 as a “select agent,” a group of dangerous pathogens that require extra precautions during shipping and handling. Standard ways to show a vaccine works, such as “challenging” vaccinated animals with the virus, must take place in biosecurity level-3 (BSL-3) labs—the second-highest level. Few such labs in the U.S. can handle cattle.
Economic concerns could also stand in the way. International trading partners are often wary that influenza vaccination could “mask” an infection in an animal, even though there are tests that can distinguish between vaccination and infection. They could also worry about dairy products such as cheese and dried milk, even though there’s little risk they would contain viable virus, as they’re made from pasteurized milk. “Trade is not always based on science,” says John Clifford, who was chief veterinary officer of USDA and is now a consultant with the USA Poultry & Egg Export Council. “There are a number of countries out there that will stop stuff based upon, ‘Oh my gosh, it’s a vaccine.’”
Trade issues are a central reason why the U.S., in contrast to many other countries, has yet to approve an H5N1 vaccine for poultry, even though the virus has led to the death or culling of 90 million birds in the country’s commercial and backyard flocks since 2022. With international trade making up 18% of the U.S. dairy market, USDA has similar concerns about cattle vaccines. “We certainly could not vaccinate if we’re going to lose the export market,” Clifford says.
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The latest edition of the World Health Statistics released at the weekend by the World Health Organization (WHO) reveals that the COVID-19 pandemic reversed the trend of steady gain in life expectancy at birth and healthy life expectancy at birth (HALE). www.who.int/news/item/24-05-2024-covid-19-eliminated-a-decade-of-progress-in-global-level-of-life-expectancy
The pandemic wiped out nearly a decade of progress in improving life expectancy within just two years. Between 2019 and 2021, global life expectancy dropped by 1.8 years to 71.4 years (back to the level of 2012). Similarly, global healthy life expectancy dropped by 1.5 years to 61.9 years in 2021 (back to the level of 2012).
The 2024 report also highlights how the effects have been felt unequally across the world. The WHO regions for the Americas and South-East Asia were hit hardest, with life expectancy dropping by approximately 3 years and healthy life expectancy by 2.5 years between 2019 and 2021. In contrast, the Western Pacific Region was minimally affected during the first two years of the pandemic, with losses of less than 0.1 years in life expectancy and 0.2 years in healthy life expectancy.
“There continues to be major progress in global health, with billions of people who are enjoying better health, better access to services, and better protection from health emergencies,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “But we must remember how fragile progress can be. In just two years, the COVID-19 pandemic erased a decade of gains in life expectancy. That’s why the new Pandemic Agreement is so important: not only to strengthen global health security, but to protect long-term investments in health and promote equity within and between countries.”
COVID-19 rapidly emerged as a leading cause of death, ranking as the third highest cause of mortality globally in 2020 and the second in 2021. Nearly 13 million lives were lost during this period. The latest estimates reveal that except in the African and Western Pacific regions, COVID-19 was among the top five causes of deaths, notably becoming the leading cause of death in the Americas for both years.
The WHO report also highlights that non-communicable diseases (NCDs) such as ischemic heart disease and stroke, cancers, chronic obstructive pulmonary disease, Alzheimer’s disease and other dementias, and diabetes were the biggest killers before the pandemic, responsible for 74% of all deaths in 2019. Even during the pandemic, NCDs continued to account for 78% of non-COVID deaths.
The world faces a massive and complex problem of a double burden of malnutrition, where undernutrition coexists with overweight and obesity. In 2022, over one billion people aged five years and older were living with obesity, while more than half a billion were underweight. Malnutrition in children was also striking, with 148 million children under five years old affected by stunting (too short for age), 45 million suffering from wasting (too thin for height), and 37 million overweight.
The report further highlights the significant health challenges faced by persons with disabilities, refugees and migrants. In 2021, about 1.3 billion people, or 16% of the global population, had disability. This group is disproportionately affected by health inequities resulting from avoidable, unjust and unfair conditions.
Access to healthcare for refugees and migrants remains limited, with only half of the 84 countries surveyed between 2018 and 2021 providing government-funded health services to these groups at levels comparable to their citizens. This highlights the urgent need for health systems to adapt and address the persisting inequities and changing demographic needs of global populations.
Despite setbacks caused by the pandemic, the world has made some progress towards achieving the Triple Billion targets and health-related indicators of the Sustainable Development Goals (SDGs).
Since 2018, an additional 1.5 billion people achieved better health and well-being. Despite gains, rising obesity, high tobacco use and persistent air pollution hinder progress.
Universal Health Coverage expanded to 585 million more people, falling short of the goal for one billion. Additionally, only 777 million more people are likely to be adequately protected during health emergencies by 2025, falling short of the one billion target set in WHO’s 13th General Programme of Work. This protection is increasingly important as the effects of climate change and other global crises increasingly threaten health security.
“While we have made progress towards the Triple Billion targets since 2018, a lot still needs to be done. Data is WHO’s superpower. We need to use it better to deliver more impact in countries,” said Dr Samira Asma, WHO Assistant Director-General for Data, Analytics and Delivery for Impact. “Without accelerating progress, it is unlikely that any of the health SDGs will be met by 2030.”
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The two-year effort to produce a global pandemic treaty did not meet its deadline.
On Friday, Tedros Adhanom Ghebreyesus, director general of the World Health Organization, announced that the negotiators – from the group’s 194 member nations – couldn’t find consensus in time for the World Health Assembly that starts next week.
The goal had been to draw up a document that could be adopted at the meeting and then sent to countries for ratification. But the sticking points – including the willingness of richer countries to share vaccines and treatments with less well-off countries in the Global South – could not be resolved in time.
Nonetheless, Tedros holds out hope.
“The world still needs a pandemic treaty. Many of the challenges that caused the serious impact during COVID-19 still exist,” said Tedros. “So let’s continue to try everything.”
Experts in global health expect that WHO will grant another six to 12 months for negotiators to complete their work – and resolve the sticking points.
“It was a huge disappointment,” says Lawrence Gostin, a professor of global health law at Georgetown University, after learning about the delay. “But there is a strong appetite to carry on.”
In the U.S., lawmakers on both sides of the aisle have sought to ensure that any agreement would not infringe on a pharmaceutical company’s proprietary information or stifle investment in drug development. A number of Republican governors have also raised concerns about whether the pandemic treaty could grant the WHO too much authority in a public health emergency.
Roland Driece, a top official in the negotiations, says that such concerns reflect disinformation about the treaty that has been circulating. He says that false claims include that WHO would have the ability to require lockdowns and mandate vaccinations.
The idea of a treaty was born at the height of the COVID pandemic when glaring gaps in the world’s collaboration and coordination became apparent – and many lives were lost as a result. By one count, more than a million people died because dozens of poor countries had next to no vaccines while some wealthier nations were giving out boosters.
