Covid-19 is coming to Europe, but it’s not all that: Vaccine options are confusing and the public may be frustrated by the lack of exposure to vaccine
A new wave of Covid-19 may be coming to Europe, but public health experts warn that vaccine fatigue and confusion over types of shots will likely cause more people to not take their vaccine.
New Omicron subvariants are gaining on the Omicron subvariants BA.4/5 that dominated this summer. The WHO said this week that scientists are tracking hundreds of new forms of Omicron.
There were over 1.5 million cases in the EU last week, up 8% from a week before, despite the fall in testing. Globally, case numbers continue to decline.
The week ending October 4th, Covid-19 hospital admissions with symptoms went up by 32% in Italy and intensive care admissions went up by 21%.
There are two types of vaccine available in Europe as of September, one for the BA.1 and another for the BA.4/5 subvariants. The only shots that have been approved are the BA. 1-tailored ones.
European and British officials have endorsed the latest boosters only for a select groups of people, including the elderly and those with compromised immune systems. Complicating matters further is the “choice” of vaccine as a booster, which will likely add to confusion, public health experts said.
The lack of a major publicity campaign coupled with the belief that it’s all over means that people may be less concerned about their risk. “So on balance I fear that uptake will be quite a bit lower.”
Penny Ward, visiting professor in pharmaceutical medicine at King’s College London, said: “Another confounder is that quite a high proportion of the population might have also had a Covid episode in recent months.”
However, weekly vaccine doses administered in the EU were only between 1 million and 1.4 million during September, compared with 6-10 million per week during the year-earlier period, ECDC data showed.
“There must be some complacency in that life seems to have gone back to normal – at least with regards Covid and people now have other financial and war-related worries,” said Adam Finn, chair of ETAGE, an expert group advising the WHO on vaccine preventable diseases in Europe.
The government is ill prepared for the autumn- winter season, and a publication on its management has been blocked, according to Italy’s Gimbe science foundation.
Meanwhile, British officials last week warned that renewed circulation of flu and a resurgence in Covid-19 could pile pressure on the already stretched National Health Service.
The Morning Observations: Breaking the Paxlovid Cycle in the US and Improving Workers’ Safety During the Pandemic
First, a programming note: This is my last newsletter before starting a book leave. I’ll be back in late January. Until then, other Times journalists will be writing The Morning, and I look forward to reading their work along with all of you.
A worrying pattern has emerged with Paxlovid and other drugs that reduce the severity of Covid: Many people who would benefit most are not receiving the treatments, and that likely causes hundreds of unnecessary deaths every day in the US.
The United States needs to collect and analyse more data. Throughout the pandemic, the country relied on data from Israel, Britain and South Africa to track the appearance of new variants and to measure the effectiveness of vaccination. The Center for Disease Control and Prevention created an analytic branch to be able to develop those capabilities. But analysis is not as good as data, and little has been done to integrate public health information into the digital age.
Improving worker safety has been another missed opportunity. Everyone in a workplace benefits if colleagues feeling flulike symptoms remain home. The provision of paid sick leave is important for those in low-income jobs and the gig economy. Paid sick leave is particularly important in the health care, hospitality, public transportation and retail industries, where infections can most easily spread. While Congress hasn’t passed legislation requiring companies to provide paid sick and family medical leave, they have spread a mountain of data about workplace infections to the public.
Instituting proactive outreach will be valuable in future emergencies — whether pandemics, hurricanes, wildfires or other disasters. Otherwise, these underserved groups will again be left out, widening disparities in care and outcomes.
Personal Protective Equipment for Children with Mental Health Needs: An Overview from the National Institutes of Health (NIH) and the Journal of Pediatric Clinical Trials
The government has yet to ensure a stable domestic production capacity and raw material supply chains for personal protective equipment, including N95 and KN95 face coverings, gloves and disposable gowns, much less pharmaceuticals.
It has not fixed the system of clinical research, which showed slow results on a range of concerns, such as the evaluation of drugs to relieve Covid symptoms and prevent hospitalizations, and optimal vaccine schedules. The good clinical results proving the benefits of steroids and hydroxychloroquine were from Britain and other countries. Yet the National Institutes of Health have not revamped how they organize, fund and reward scientists for participating in large, pragmatic clinical trials, especially but not only in public health emergencies.
The president of the American Academy of pediatrics is a doctor named Moira Szilagyi. The views expressed in this commentary belong to the author. View more opinion at CNN.
Across the country, some hospitals report they are inching toward 100% of their capacity to care for sick children. Emergency departments can be long and crowded. This is something that needs to be done. Some kids with viral illnesses like respiratory syncytial virus (RSV) and Covid-19 need critical medical support, so they need rest and care at home. The overwhelmed health system can make it hard for some families to get care for a child in an emergency.
Many emergency department and inpatient beds are occupied by children and adolescents who have mental health needs. They are not necessarily the right places to receive mental health care. It is because there is literally no other place to send them.
The Rise and Fall of the West : What Are We Really Doing About the Health Problems in Sub-Saharan Africa?
For parents, I can offer some reassurance – and some advice. Now is a good time to get vaccine for flu and Covid-19 if you haven’t done so before. Regular hand washing, staying home if you are sick and covering your mouth and nose to reduce viral transmission from coughs and sneezes will all help.
Most illnesses can be treated at home, but if you are worried about your child’s symptoms, don’t hesitate to call your child’s pediatrician. Try to be patient, as they are most likely fielding a high number of calls from other parents and caregivers.
The past president of the Nigerian Academy of Sciences is Tomori. I had asked him if he was surprised that high-income countries were buying up the vaccine supplies and that the World Health Organization was sharing the vaccine with non-African countries.
He is not upset about the global health inequalities because he believes they are inevitable. The real issue, he says, is that African countries rely too much on the West — which is not exactly a formula for success. For one, Tomori says, Western aid always comes too little, too late. But more important, he stresses, “your help is not helping us. It’s making us more dependent.”
One of the primary steps toward biosecurity is comprehensive disease surveillance to help rapidly identify and contain novel pathogens — this includes the health-care system treating patients, public health labs conducting tests and epidemiologists coordinating the response. The World Bank invested hundreds of millions of dollars in Africa to help with this, but Mombouli says the country still hasn’t done enough to stop the spread of diseases.
There aren’t many countries in sub-Saharan Africa with a single medical school. In addition, there are only 20 countries with a single medical school. The WHO projects that Africa will be short 6.1 million health-care workers by the year 2030, less than the cutoff for the UN’s sustainable development goal.
Developing a value chain for infectious diseases: From Ebola to the Congo to the Likouala and Aspen pharmacies
During the West African Epidemic, it took nearly three months for the virus to be identified in Guinea. WHO reported that the country took so long because “Clinicians had never managed cases. No laboratory ever diagnosed a specimen from a patient. No government had ever witnessed the social and economic upheaval that can accompany an outbreak of this disease.” So when the virus was finally identified as Ebola, it was already “primed to explode.”
Mombouli also gives the example of Likouala Prefecture, a swampy area in northern Congo and one of the poorest, least developed regions in the country. He calls Likouala a “paradise for pathogens,” rife with everything from the disease-causing bacteria treponema to the viral disease Rift Valley Fever. “You know something terrible is going to come out of that area,” he says. Without proper pathogen monitoring, it’s only a matter of time.
Local hunters began reporting the carcasses they found so that the network could test them for the deadly disease. The end product was a surveillance system that covered 50,000 square kilometers of the most rural regions in the Republic of Congo.
As such, Mombouli thinks the continent should develop its own epidemic “value chain,” a term referring to the entire manufacturing process from acquiring raw materials to distributing finished products. Currently, there are a few African manufacturers who have experience making vaccines from start to finish, such as the Biovac Institute in South Africa which produces a hepatitis B vaccine and theInstitut Pasteur de Dakar inSenegal which produces a yellow fever vaccine.
But building the value chain for novel health threats has proved more elusive. In the case of COVID-19, for instance, mRNA vaccine technology is a closely guarded secret.
If the company moves, we will go back to square one. Aspen pharmacare could soon be forced to shut down its plant in South Africa because of insufficient demand due to hesitancy and difficulties in distributing the vaccine, among other reasons.
This will take time, with testing expected to begin later this year and the vaccine approval expected in 2024, but there can be a lot done in the interim. African countries can identify other parts of the value chain where they can contribute immediately according to Tomori. One can make a variety of items like glass, rubber, testing, and so on. Tomori says each country doesn’t need to produce everything end-to-end, but should start somewhere.
But things are beginning to change. According to the WHO, four African countries have more workers per 1,000 than the threshold.
This fledgling success stems from government prioritization. In a recent paper in World Health and Population, authors from Namibia’s Ministry of Health and Social Services described how they used a WHO tool to diagnose the country’s staffing shortcomings. They made evidence based decisions about redeploying health-care workers and expanding the scope of practice of nurses because of this data.
While it’s critical to continue building more medical institutions, such as the Kenyan General Electric (GE) Healthcare Skills and Training Institute and the University of Global Health Equity in Rwanda, there must also be a focus on retention.
In a study published in the British Medical Journal, it was estimated that sub-Saharan African countries lost $2 billion because doctors moved abroad. “Africa has to look inward and start paying people the salary they deserve,” Happi asserts, “so that they don’t leave the continent for elsewhere.” The Zimbabwean Nurses Association claims that nurses in the country earn less than the average for the World Bank’s international poverty line.
This isn’t going to stop health-care workers from coming to Africa, but it is going to give the West more money to help replenish their workforce. “If you are honest, you will be able to say that you cannot deplete a continent’s own resources,” he says.
That’s not to say African-Western partnerships shouldn’t be pursued. The first one to identify the omicron variant was Sikhulile Moyo, the laboratory director of the Gaborone-Harvard AIDS Institute Partnership. Before any US hospital had COVID-19 tests, Happi and Broad Institute computation geneticist Pardis Sbeeti deployed them in hospitals in Nigeria, Senegal and Sierra Leone. A scholarship fund for students at the University of Global Health Equity has been announced by Partners in Health.
How do we look at and understand the epidemic? Seven years of warning about the need for vaccines and the environmental impact on disease prevention in the United States
Simar Bajaj is an American freelance journalist who has previously written for The Atlantic, TIME, Guardian, Washington Post and more. He studies the history of science and chemistry at Harvard University, and has a research fellowship at Massachusetts General Hospital. Follow him on his social media sites.
What are they? There is no simple or silver-bullet solution, which may be another reason we’ve spent more energy on the need for vaccination than on the vulnerabilities of age (that is, the fix is far more straightforward). But clearer communication — from public health officials to politicians and the media — about differential risk could nevertheless help, emphasizing not just that more shots are good but that different groups probably need different approaches, and that even with up-to-date vaccination and bivalent boosting, infection represents a considerable threat to older adults.
One answer is that as a country, we prefer to not see those deaths at all and just ignore them, like a kind of background noise or wallpaper. We don’t need to understand who is dying or why in part because we don’t want to reckon with the fact that around 300 Americans are now dying from Covid-19 every day, at a rough pace of about 100,000 per year, making it the country’s third leading cause of death. This is normalization at work, but it is also a familiar pattern: We don’t exactly track the ups and downs of cancer or heart disease either.
In the last few years the country has tried to consider both individual risk and social risk separately. We seemed to build our sense of individual risk back to the needs of the social environment, instead of focusing on the differential threat. With the arrival of vaccines, we began to build a collective picture of social risk in the opposite way, up from an individual basis instead.
With effective, available vaccines against devastating diseases, governments could prevent escalation through contact tracing and ring vaccination: in the case of Ebola, perhaps a few dozen contacts of each infected person could be vaccinated. But producing the small number of doses needed to prevent spread is not profitable for drug companies, and donor governments are reluctant to waste money on preventive vaccines that might never get used.
I warned about this problem seven years ago in a column in Nature (S. Berkley Nature 519, 263; 2015). Yet despite the COVID-19 wake-up call, this remains one of the biggest chinks in our pandemic-preparedness armour.
‘Short-sighted’ hardly describes the situation. Preparing preventive vaccines for a few million dollars per batch should be seen as a small insurance policy to avoid a repeat of the US$12 trillion the world just spent on COVID-19.
I will not be writing about this again seven years from now, what will it take to catalyse change? It’s been a long time since we did not talk about this issue to living through a Pandemic that daily highlights its relevance. I am optimistic that a change in mindset is in view.
Wealthy countries should take the lead. They should ensure that agencies such as the Coalition for Epidemic Preparedness Innovations (CEPI), based in Oslo, and the International AIDS Vaccine Initiative (IAVI), based in New York City, are fully funded to do this work, which will involve close collaboration with government research agencies as well as Gavi, the Vaccine Alliance, and the WHO.
This month, Anthony Fauci will step down as director of the US National Institute of Allergy and Infectious Diseases (NIAID) after more than 38 years in the post and 54 years at its parent organization, the US National Institutes of Health (NIH). He has led the institute under seven US presidents and overseen its research and response to the HIV/AIDS epidemic, as well as the COVID-19 swine flu outbreak. The 81-year-old physician-scientist became a household name during the pandemic, during which he was revered as a trusted source of advice by some and disparaged by others, including former US president Donald Trump, who saw his advice as inconsistent and overbearing. He was attacked on 11 December by Musk, who took over the site in October. Fauci spoke to Nature about Musk’s comments, the pandemic and his own legacy.
HIV is one of the most important topics in this area. In 1981, when we first became aware of the cases of HIV, [it was] a mysterious disease of unknown etiology that was killing virtually everybody who was infected. It was not a good period for my career in infectious diseases. We didn’t know what was killing these young gay men, we didn’t know how to test for HIV, and we couldn’t use drugs because they were too expensive, but we did know how to treat HIV. Highly effective prevention methods with pre-exposure prophylaxis and treatment bring the level of virus to below detectable levels so they don’t transmit it to anyone else.
A safe and effective vaccine for HIV is one of the holy grails of infectious disease research. We have made great strides in the treatment and prevention of disease. A safe and effective vaccine is something we have been trying to get, but it hasn’t been easy. One of the things we look forward to is that. There is a chance that you can have a cure for HIV if you do not take any further therapies. We have not reached that point yet, but that is an aspirational goal.
Yes, we do. And you do it by just doing it. It is not difficult to mix the disciplines of social sciences and the disciplines of hard sciences to develop vaccines. In our country, we have 32% of the population getting the primary vaccine for COVID. Only half of them have been given a boost. And importantly, [despite] the availability of an effective BA.4/5 bivalent updated booster, only 13% of the eligible population has received it. It is disturbing and embarrassing to know that we do not have an enthusiasm for getting a life-saving vaccine.
Mental Health: What I’ve Learned from COVID-19, Why I’m Not a Tweeter, but a Censpool of Misinformation
The importance of mental health is one of the things brought to the fore by COVID-19.Stress that has come about as a result of the Pandemic has also put on the general population, including children. [Their] growth and development has been [shaped] not only by missing in-person school, but also by the stress of losing grandparents and parents, and seeing the disruption of the normal flow of their childhood. The impact on mental health from all of that has been negative.
That’s impossible to answer. If countries and groups are not transparent, that may be a problem for the global public-health effort. I would hope that all of the countries understand that we need to be transparent and cooperative in everything that we do, because infectious diseases can be spread easily, especially when they have a respiratory route. We saw that very painfully with how COVID spread throughout the world and has already resulted in close to seven million deaths, and that’s probably a gross underestimate.
Max, I don’t feel like I need to respond to that. I don’t tweet. I don’t have a Twitter account. A lot of that stuff is just a cesspool of misinformation, and I don’t waste a minute worrying about it.
It is at risk. Federal agents are armed with me all the time. That stirs a lot of hatred in people who have no idea why they are mad, because a person like that is using social media.
Source: https://www.nature.com/articles/d41586-022-04432-7
Public Service and Public Health: What I’ve Learned and What I Don’t (But I’m All Right) About It
I encourage them to get into public service and public health because they’re so satisfying and can make a huge impact on society. It is truly extraordinary. The bad stuff was overcome by it. It’s unfortunate that we are going through the attacks on public-health officials. But the satisfaction and the accomplishments you can [achieve] in the field are great. It supersedes all the other stuff.