by Charlotte Kilpatrick | Sep 16, 2024 | Global Health |
A paper in npj vaccines in September 2024 explores the significance of “biased processing” of information relating to vaccines in addressing vaccine hesitancy during the COVID-19 pandemic. Although vaccine hesitancy is influenced by various factors, the research suggests that “deliberate ignorance” was more closely associated with vaccine refusal than “typically investigated demographic variables”. This emphasises the importance of tailored information to meet individual information-processing needs.
Hesitancy and interventions
Vaccine hesitancy, “the reluctance or refusal to get vaccinated despite the availability of vaccines”, was recognised as a top ten global health threat by WHO in 2019. The authors acknowledge that it is a “complex phenomenon”, determined by “historical, political, and socio-cultural factors” as well as “individual knowledge and risk perception”.
Recent research has highlighted the significance of concerns about side effects and effectiveness for vaccine hesitancy. Therefore, many responses to vaccine hesitancy use information on vaccine evidence, including possible harms or potential benefits. However, there is evidence that “transparent communication of the evidence” does not influence vaccination intentions and neglects factors such as experiences of racism or mistreatment by medical professionals or distrust of the pharmaceutical industry.
The study
The authors consider “how (if at all) people use information about vaccine evidence”. They combine theoretical and analytical ideas with methodological tools from cognitive and behavioural science to investigate how individuals with different attitudes towards COVID-19 vaccines process vaccine evidence information. They characterise and measure how people process “commonly provided information about vaccine evidence” and compare the influence of “extraneous factors” on vaccination decisions.
With a process-tracing methodology and computational modelling, the authors examine the extent to which people may engage in “deliberate ignorance”. In this context, deliberate ignorance signifies “choosing not to inspect a piece of information on a vaccine’s side effects, benefits, and their probabilities in the pre-decision phase”. Deliberate ignorance is distinguished through three levels:
- Full deliberate ignorance – people abstain from inspecting any information on vaccine evidence; their decisions may be based on other factors instead.
- Partial deliberate ignorance – people ignore some, but not all, vaccine evidence information. The research focusses on ‘probability neglect’, in which a vaccination outcome is inspected, but its probability is not.
- No deliberate ignorance – people inspect all information on vaccine evidence and consider it in their decision. However, even in this category this information may be processed in a distorted fashion, deviating from a “rational way” of processing information.
As vaccination decisions are conceptualised as “instances of risky choice”, the authors use a framework that considers two types of cognitive distortions: (nonlinear) probability weighting and loss aversion:
- Probability weighting – people make risky decisions as if they processed probabilities nonlinearly, with low and high probabilities being over- and underweighted.
- Loss aversion – people make risky decisions as if the psychological impact of losses is greater than that of gains.
The online study involved 1200 United States citizens who self-reported as having anti- (365), neutral (373), or pro- (462) COVID-19 vaccine attitudes. Participants made a series of decisions concerning their willingness to get vaccinated with each of eight internationally licensed COVID-19 vaccines. For each of these vaccines, participants could choose to inspect information on vaccine evidence, including side effects and benefits. Information inspection behaviour was recorded through Mouselab, a process-tracing tool.
Findings
61.9% of participants in the anti-vaccination group, 11.7% of participants in the neutral group, and 0.4% of participants in the pro-vaccination group refused all eight vaccines. On average, participants accepted one (anti-vaccination), three (neutral), and five (pro-vaccination) of the eight vaccines. Notably, the non-zero acceptance rate in the anti-vaccine group was influenced by almost 30% of participants indicating willingness to accept the Bharat Biotech vaccine.
The strongest predictors of vaccine acceptance were vaccination attitude, the number of COVID-19 vaccinations a participant had received by the time of the study, and vaccine brand. Political orientation and education level were related to vaccination decisions in raw data, but these relationships “vanished” in the full statistical model.
Statistical models were used to investigate the relationship between deliberate ignorance of vaccine evidence and vaccination decisions. Mouselab data facilitated an analysis of participants’ information inspection behaviour. This found that anti-vaccination, neutral, and pro-vaccination groups exhibited full deliberate ignorance in 18%, 9%, and 7% of decisions respectively. The level of deliberate ignorance was “strongly related” to vaccination decisions; probability of vaccine refusal was highest when participants exhibited full deliberate ignorance and lowest when they exhibited no deliberate ignorance.
“In the anti-vaccine group, full deliberate ignorance was almost always followed by vaccine refusal; in the pro-vaccination group, by contrast, full deliberate ignorance was associated with a higher probability of vaccine acceptance than partial deliberate ignorance.”
Probability neglect was defined as cases in which there was at least one instance where a participant inspected an outcome but not its probability. Participants in the anti-vaccination, neutral, and pro-vaccination groups exhibited probability neglect for side effects in 15%, 13%, and 9% of vaccination decisions respectively. For benefits, they exhibited this in 8%, 6%, and 4% of decisions respectively.
To account for the possibility that the effect of probability neglect on vaccination decisions depended on side effect severity, the authors distinguished whether the probability neglect occurred for an “extreme, severe, or mild” side effect or for a benefit. This revealed that vaccine refusal was “much more likely” in trials where the probability of an extreme side effect was neglected, and vaccine refusal was “much less likely” in trials where the probability of a mild side effect was neglected.
“How participants inspected and ignored information about vaccine evidence seemed to be a key predictor of their decision to get vaccinated with given vaccine or not.”
The authors then used computational modelling to explore cognitive distortions in the processing of the inspected vaccine evidence and its effect on vaccination decisions. For quantitative measures of each participant’s subjective valuation of a vaccine’s possible outcomes, participants were asked to rate the emotion they would feel due to each effect. The anti-vaccination group gave the most negative affect ratings for side effects and the least positive affect ratings for benefits; the pro-vaccination group gave the least negative affect ratings for side effects and the most positive affect ratings for benefits.
To investigate how vaccination decisions were driven by individual decision biases, vaccine-specific effects, and subject distortion of vaccine evidence, the authors developed a computational model to capture paths to a decision. This identified a decision bias in most of the anti-vaccination group to refuse the vaccine; this was strong that the effects of the vaccine’s properties and valuations “rarely pushed the probability of acceptance” higher than 50%.
Neutral group participants showed a “weak a priori propensity to refuse a vaccine” but vaccination decisions were driven by vaccine-specific effects and consideration of vaccine evidence information. Most participants in the pro-vaccination group showed a bias towards vaccine acceptance, but this was not as pronounced as the refusal bias in the anti-vaccination group.
“The subjective valuations of the vaccine’s effectiveness, side effects, and probabilities drove the vaccination decisions, particularly among the neutral and pro-vaccination participants.”
Implications for vaccine interventions
An insight that the authors highlight is the importance of “tailoring interventions” to specific target groups. If a person is asked to self-assess their general vaccination attitude, the content and format of vaccine information could be adjusted. Although the deliberate ignorance of vaccine evidence among the anti-vaccination group is a “practical barrier to the approach of risk communication that is meant to inform but not persuade”, health communicators and health authorities should not abandon their goal of informing.
“Risk evidence communicators need to be realistic about their expectations. It also means that they must consider other aspects of their efforts, such as the relationship between the communicator and the audience.”
Communicators must also explicitly address the “major concerns” of vaccine sceptical people, such as “what science does not know”; this must be communicated in “understandable, nontechnical, and transparent language”. However, once trust is re-established among people with anti-vaccination attitudes, the “tendency to close one’s eyes to probabilities” presents a challenge. Targeted interventions that address this “disregard of probabilities” would be useful. For example, interactive simulations could be used to convey vaccine evidence, imitating the “sequential and experiential mechanisms by which people naturally encounter risk information”.
The observed side-effect aversion in all groups might lead communicators to avoid disclosing side effects. This could initially decrease vaccine hesitancy but “at a huge cost”. Full transparency is critical for maintaining trust. Again, interactive simulations might be a solution, or targeting the strong negative emotions associated with side effects.
Concluding that behavioural scientists have the “task” of understanding the reasons for vaccine refusal, the authors emphasise the need for effective evidence communication to take “new and innovative paths”.
“Societies can be fully prepared for future pandemics only when technological ingenuity is coupled with cognitive and behavioural insights.”
If the ideas explored in the study are of interest to you, you could participate in the pre-Congress Vaccine Equity Workshop in Barcelona next month; you will hear from experts on the importance of effective vaccine outreach and how social and cultural factors contribute to vaccine inequities. Don’t forget to subscribe to our weekly newsletters here for the latest vaccine news.
by Charlotte Kilpatrick | Sep 12, 2024 | Global Health |
A study in Open Forum Infectious Diseases in September 2024 estimates the number of deaths averted through vaccination in Latin America and the Caribbean Region (LAC) during the first year and a half of vaccination efforts. The study spans January 2021 to May 2022 and includes 17 countries in LAC. The authors estimate that vaccination efforts resulted in between 610,000 and 2.61 million deaths averted. Their findings “underscore the substantial impact of timely and widespread vaccination” and provide “crucial support” for vaccination programmes against epidemic infectious diseases and future pandemics.
Rapid response
WHO’s declaration of a global pandemic in March 2020 prompted the development and implementation of “control and mitigation plans” around the world. Despite these efforts, COVID-19 caused “substantial health and socioeconomic losses and significant mortality”; more than 7 million deaths due to COVID-19 were reported since 1st January 2020. Countries in the Americas were “among the hardest hit by the pandemic”, with approximately 43% of all reported COVID-19 deaths reported from the region by 2023. By spring of 2023, South America experienced 1.35 million COVID-19 deaths.
Vaccines against COVID-19 became available for use in Latin America and the Caribbean in early 2021. In July 2021, eight COVID-19 vaccines had received Emergency Use Listing (EUL) through WHO pre-qualification. This increased to 15 by May 2023, with others under assessment for pre-qualification.
“The rapid deployment of vaccines has been proven critical to halt the pandemic’s toll in the region.”
PAHO’s Revolving Fund enabled many countries to access vaccines. In LAC countries, 82% of the population had received at least one dose of a COVID-19 vaccine by spring 2023. However, “wide inter- and intra-country variation in access and availability” were identified in the region.
The study
The researchers sought to estimate the number of COVID-19 deaths averted through vaccination in selected countries of the LAC region during the pandemic. They used existing data on reported deaths and vaccination coverage from 17 countries in the region during the period from vaccine introduction in each country to May 2022. The countries selected were Argentina, Belize, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, El Salvador, Guatemala, Honduras, Jamaica, Mexico, Paraguay, Peru, Uruguay, and Venezuela. Other countries in the region were excluded due to missing data. The analysis considered adults over 18, stratified by age (18-59 and 60+).
1.05 million COVID-19 deaths were reported in 17 countries considered between the start of vaccination, which ranged by country from December 2020 to March 2021, to May 2022. The analysis accounts for underreporting to assume that there were likely 1.49 million COVID-19 deaths in these countries during this time. The model estimates that, without vaccination and assuming medium vaccine effectiveness, there would have been 2.67 million deaths during this period. This means that an estimated 1.18 million deaths were averted by vaccination; the estimate ranges between 610,000 deaths averted with low vaccine effectiveness and 2.62 million deaths averted with high vaccine effectiveness.
“Overall, our model estimates that approximately 273 (142-607) deaths were averted per 100,000 people in LAC.”
The authors believe that this study is the first multi-country study to evaluate the effect that vaccination had on COVID-19 deaths in the LAC region, estimating up to 2.6 million deaths averted. As LAC countries faced “various challenges” in implementing their vaccination campaigns, the study can “help inform policy and decision-makers of the outcome of these campaigns”. Future research is needed to provide in-depth analyses of countries to assess differences in vaccine effectiveness by specific region or population group and evaluation of potential alternative vaccination scenarios.
“Despite the many challenges to COVID-19 vaccination in LAC – including timely access to vaccines, varying vaccine products and schedules, evolving circulating variants, and shifting vaccination strategies and target groups – these findings underscore the substantial impact of timely and widespread vaccination in averting COVID-19 deaths.”
At the Congress in Barcelona this October we will hear from a panel of experts on how we can establish a “sustainable vaccine production ecosystem” in Latin America, with implications for future vaccination strategies. Get your tickets here to join us for this session, and don’t forget to subscribe to our weekly newsletters here.
by Charlotte Kilpatrick | Sep 12, 2024 | Global Health |
Bavarian Nordic issued an update on its supply and manufacturing activities in support of mpox response efforts in September 2024. The company manufacturers the approved non-replicating smallpox and mpox vaccine MVA-BN (marketed as JYNNEOS, IMVAMUNE, and IMVANEX). The company statement describes “intensified” collaboration with global stakeholders in response to the declaration of mpox as a PHECS by Africa CDC and a PHEIC by WHO.
Progress so far
Through donations from the European Commission, the United States government, and Bavarian Nordic, initial doses of MVA-BN have been delivered to the Democratic Republic of the Congo (DRC), the epicentre of the mpox outbreak. Further donations have been pledged by other countries. However, UNICEF and Africa CDC have suggested that vaccines will be needed to protect up to 1 million people in high-risk areas of DRC, with up to 10-12 million doses required through 2025.
Bavarian Nordic “is committed to ensuring equitable access to its mpox vaccine”. It has therefore prioritised the production of MVA-BN for the rest of the year to ensure up to 2 million doses by year-end. This means that some existing orders for 2024 will be delayed to 2025 to provide “greater flexibility” to meet “additional urgent and imminent needs”. The new supply contracts include multi-year agreements with countries, including those who have pledged vaccines for Africa. Additionally, Bavarian Nordic has responded to UNICEF’s emergency tender and is participating in discussions with other organisations and individual governments around the globe.
Up to 13 million doses
By focussing “full capacity to address the current public health emergency”, Bavarian Nordic hopes to supply up to 13 million MVA-BN doses by the end of 2025. This includes 2 million in 2024. Although this may be sufficient to meet the current and near future demand, Bavarian Nordic is exploring “additional levers” to expand capacity. This includes possibly transferring manufacturing to other companies.
“Based on these early, but highly constructive discussions, together with further planned improvements in the manufacturing process, Bavarian Nordic has identified another 50 million doses that, pending regulatory approvals and demand, could be supplied during the next 12-18 months.”
President and CEO of Bavarian Nordic, Paul Chaplin, stated that the company is “working closely with all governments and organisations to support the international efforts to combat the latest public health emergency”. Mr Chaplin highlighted that Bavarian Nordic will “support all requests for vaccine and have already secured agreements to the UNICEF tender that will hopefully secure more access to MVA-BN globally”.
“We remain committed to the equitable access either through prioritising our own capacity, accelerating planned improvements in the manufacturing process and by exploring ways to further expand capacity through partnerships around the globe. Once again Bavarian Nordic, through innovation and our commitment to improving and saving lives has stepped forward as an important part of the international community’s response to the current public health emergency.”
We will hear more from Bavarian Nordic on their contributions to the mpox response at the Congress in Washington next April; get your tickets to join us there and don’t forget to subscribe to our weekly newsletters here.
by Charlotte Kilpatrick | Sep 12, 2024 | Global Health |
In September 2024, Merck (MSD) announced positive top-line results from its pivotal Phase III trial evaluating the company’s 9-valent Human Papillomavirus (HPV) vaccine, GARDASIL 9, in young males in Japan. The trial met its primary and secondary endpoints, proving that administration of a 3-dose regimen of GARDASIL 9 reduced the combined incidence of anogenital persistent infection caused by 9 types of HPV compared to a placebo. Merck will share the data with regulatory authorities in Japan and other countries to support licensure for use in males.
V503-064
V503-064 is a Phase III, double-blind, placebo-controlled clinical study to evaluate the safety, tolerability, and efficacy of GARDASIL 9 (V503) in preventing HPV-related anogenital persistent infection in Japanese males between the ages of 16 and 26. It enrolled 1,059 participants. The primary efficacy objective was to demonstrate reduction in the incidence of HPV 6/11/16/18-related 6-month anogenital persistent infection. The secondary efficacy objective was to demonstrate reduction in the incidence of HPV 31/33/45/52/58-related 6-month anogenital persistent infection.
Dr Eliav Barr, senior vice president, head of global clinical development and chief medical officer, Merck Research Laboratories, highlighted that “a decade after the first approval of GARDASIL 9, Merck continues to evaluate this important vaccine in additional patient populations”. Dr Barr emphasised Merck’s commitment to “helping prevent certain HPV-related cancers through broad and equitable access globally”.
“These data build on the clinical efficacy of GARDASIL 9 for the prevention of persistent infection in males and can potentially make a significant impact in addressing the global burden of certain HPV-related cancers and diseases.”
Merck’s clinical development programme evaluating GARDASIL 9 in males includes an ongoing confirmatory Phase III trial evaluating efficacy in preventing HPV oral persistent infection to support effectiveness against HPV-related oropharyngeal and other head and neck cancers.
For the latest vaccine research updates at the Congress in Barcelona this October, get your tickets to join us here and don’t forget to subscribe to our weekly newsletters here.
by Charlotte Kilpatrick | Sep 11, 2024 | Global Health |
An FDA-funded study in eClinical Medicine explores the clinical characteristics, myocardial injury, and longitudinal outcomes of COVID-19 vaccine-associated myocarditis (C-VAM). The authors provide a “detailed phenotypic clinical characterisation” of C-VAM in 33 children, adolescents, and young adults. They also present longitudinal myocardial tissue information in vaccine-associated myocarditis and data on the cardiovascular outcomes of the complication. The results point to a need for “continued clinical surveillance and long-term studies in affected patients”.
Myocarditis and mRNA
Although vaccination is a “public health cornerstone” in managing the SARS-CoV-2 pandemic, mRNA vaccines have been associated with a “rare complication”: myocarditis. Acute myocardial injury and chronic scarring in childhood myocarditis can be characterised by late gadolinium enhancement (LGE) by cardiac magnetic resonance (CMR) imaging. Despite recent research into the rate of myocardial injury with COVID-19 vaccine-associated myocarditis (C-VAM), the natural history, implications, and overall prognosis for young patients with C-VAM are “insufficiently studied”.
The study
The authors hoped to describe the initial clinical and cardiac imaging characteristics of C-VAM, explore possible risk factors for myocardial injury, and evaluate cardiovascular outcomes in a large cohort of young people diagnosed with C-VAM. They conducted a longitudinal multicentre retrospective observational study across 38 United States member institutions of the Myocarditis After COVID Vaccination (MACiV) study network, comprising paediatric cardiologists and CMR experts.
Participants were up to or 30 years old, with a clinical diagnosis of acute myocarditis after COVID-19 vaccination based on clinical presentation, abnormal biomarkers, and/or cardiovascular imaging findings. The researchers collected biomarkers of myocardial injury (troponin), heart failure (brain-natriuretic peptide BNP or NT-pro-BNP), and systemic inflammation (erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP]). They also collected results from electrocardiograms (ECGs), telemetry, Holter monitoring, echocardiography, and CMR.
433 patients were enrolled, including 333 with C-VAM and 100 with multisystem inflammatory syndrome in children (MIS-C). 95% of patients had been vaccinated with the monovalent Pfizer-BioNTech COVID-19 mRNA vaccine. 5% had received the monovalent Moderna COVID-19 mRNA vaccine. One patient was also reported to have received the Johnson & Johnson vaccine.
Findings
When they investigated possible risk factors for LGE in C-VAM, the authors found that the odds of having LGE in C-VAM were 2.74 times higher for older adolescents (>15 years) than younger patients, 3.28 times higher for males than females, 7.18 times higher after the first dose, and 4.5 times higher after the second dose than the third dose. The authors note that C-VAM patients in the studied cohort were “predominantly males who presented with chest pain and elevated troponin”. Although clinical course was “nearly always mild” with low prevalence and extent of cardiac dysfunction, myocardial injury was “common”, as demonstrated by higher troponin levels and LGE in 82%.
As LGE is “common” in C-VAM, the authors suggest that the myocardial damage in C-VAM could be attributable to a process that targets cardiomyocytes, leading to injury. Myocardial injury was indicated by imaging markers of cardiomyocyte necrosis and oedema. C-reactive protein was more likely to be elevated than ESR and correlated with LGE severity and lower left ventricular ejection fraction (LVEF) during initial presentation. Thus, CRP “may be of greater diagnostic yield” as an inflammatory marker than ESR.
The finding that younger children were “somewhat less likely” to develop LGE and/or cardiac dysfunction and the observation that older adolescents and young adult males are at “greatest risk” for C-VAM supports the hypothesis of the “influence of sex hormones in the pathogenesis”. Oestrogen appears to have a “protective effect” in myocarditis; testosterone increases the risk of myocardial inflammation. However, it remains unknown whether oestrogen and testosterone are associated with a better or worse prognosis once C-VAM has occurred.
The comparison with MIS-C offered a “better perspective” on the severity of cardiac involvement and myocardial injury in myocarditis associated with COVID-19 vaccination in the paediatric population. MIS-C occurs through a “delayed hyperimmune response” several weeks after exposure to SARS-CoV-2. It is mediated by a non-targeted pro-inflammatory cascade that causes the dysfunction of several systems, including the heart.
The study found a “greater proportion” of white patients in the C-VAM group and black patients in the MIS-C group, which implies “differences in immunisation rates and/or an increased susceptibility to developing these complications”. MIS-C patients were “younger and sicker”; they were more likely to require intensive care management and had a higher prevalence and degree of systemic inflammatory markers and cardiac dysfunction. However, lower troponin levels, “rapid resolution” of cardiac dysfunction after immunomodulatory therapies, and a lower prevalence of LGE in MIS-C than C-VAM suggest that cardiac function was “non-specifically” affected due to the “severe systemic immune response” in MIS-C, rather than “focused injury to the heart” in C-VAM.
There is an emphasis on the need for more information on longer-term outcomes:
“Longer-term monitoring with clinical visits, serial echocardiograms, and heart rate monitoring, to assess for signs of ventricular dysfunction, the development of heart failure, and/or arrhythmias, at least in LGE positive patients, seems warranted.”
Despite C-VAM’s “mild initial course”, myocardial injury is “common”, particularly in older adolescent males who present after a first or second dose of mRNA vaccines.
“While mid-term clinical sequelae are rare and LGE severity decreases over time, the persistence of LGE at follow-up in most patients warrants continued clinical surveillance, additional research, and longer-term studies in this subset of patients.”
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by Charlotte Kilpatrick | Sep 11, 2024 | Global Health |
Gavi announced in September 2024 that a shipment of 15,460 doses of mpox vaccine has arrived in the Democratic Republic of the Congo (DRC) to “support the global and regional effort to contain the outbreak”. These doses were donated by manufacturer Bavarian Nordic to Gavi-eligible countries. Arriving in Kinshasa, the shipment adds to the 215,000 vaccine doses already donated by the European Union.
Global response
The DRC is the epicentre of the mpox outbreak; it has reported around 94% of all cases and 99% of related deaths. It has secured national regulatory approval of Bavarian Nordic’s JYNNEOS mpox vaccine and rollout is expected to begin shortly. Gavi has made US$2.9 million under the Fragility, Emergencies, and Displaced Populations (FED) Policy to support DRC’s vaccination efforts.
In August 2024, Gavi announced that the Board has approved the final terms of the First Response Fund. This is the “fastest tool in a suite of instruments” known as the Day Zero Financing Facility; this is intended to make resources “immediately” available for a vaccine response to an urgent public health emergency. Gavi is also working with countries and partners and sharing “legal and process knowledge” and operational support to Africa CDC and partners.
“Based on our experience working with donors, countries, and partners to coordinate the global COVAX dose donation mechanism, this includes providing information on the complex technical, legal, regulatory, and logistical considerations involved in mounting rapid vaccination campaigns with donated doses.”
CEO of Gavi, Dr Sania Nishtar, described the latest shipment as a “timely addition” to the global response.
“Now that they have arrived, our first priority is to work with our partners to ensure these and other vaccines reach those who need them, as quickly and efficiently as possible. Gavi has already unlocked funds to support this delivery.”
For regular updates on the global effort to stop the spread of mpox with vaccines, don’t forget to subscribe to our weekly newsletters here. To engage with experts working in this area, get your tickets to the Congress in Barcelona this October.
by Charlotte Kilpatrick | Sep 10, 2024 | Global Health |
The University of Oxford’s Centre for Cancer Early Detection and Prevention announced in September 2024 that Cancer Research UK has awarded a team of scientists up to £550,000 to carry out “underpinning work” to test a vaccine for patients with Lynch syndrome. Lynch syndrome is associated with a higher overall risk of developing some types of cancer. The vaccine, if successful, could protect people with Lynch syndrome before cancer begins to develop.
Lynch syndrome
A heritable genetic condition, Lynch syndrome is caused by an altered copy of a gene that is involved in processes that support DNA repair. Failure to repair DNA can cause damage to genes that control growth. This increases the risk of cancer. People with Lynch syndrome have a “higher overall risk” of developing bowel cancer and other cancers such as womb cancer (endometrial cancer) and ovarian cancer.
Up to 7 in 10 people with Lynch syndrome develop bowel cancer in their lifetime. It is estimated to cause around 3% of bowel cancer cases in the UK each year. Although between 175,000-200,000 people are estimated to have Lynch syndrome in the UK, fewer than 5% have been diagnosed.
Vaccine potential
The team at Oxford will analyse pre-cancerous cells from people with Lynch syndrome to determine which parts of a pre-cancer are potential immune targets. They will then design a vaccine that encourages the immune system to recognise pre-cancer cells and destroy them before they develop into cancer. The researchers will continue working with people with Lynch syndrome, who have helped to co-develop the project so far. They will also consult people living with Lynch syndrome to understand their views about using vaccination to prevent cancer.
Free from fear of cancer
Associate Professor David Church, Cancer Research UK Advanced Clinician Scientist Fellow and co-lead of the LynchVax team at Oxford reflects that “less than 5% of people with Lynch syndrome are aware that they have the condition”. However, “it accounts for an estimated 1,300 cases of bowel cancer and increases the risk of other types of cancer”.
“We hope our research will lay the early foundations to potentially prevent these cases through vaccination, removing the fear of cancer from people whose chances of developing it in their lifetime are far higher.”
Professor Simon Leedham, Honorary Consultant Gastroenterologist and co-lead of the LynchVax team agrees that LynchVax “has the potential” to reduce the “very high risk” of developing these cancers for people with Lynch syndrome.
“While our work is in its infancy, we are excited by the prospect of a vaccine that can potentially be used to prevent the multiple types of cancer that typically occur in people with Lynch syndrome and deliver tangible improvements in survival.”
Helen White is a member of the LynchVax patient and public involvement group and is “delighted” to be a part of developing the “potentially life-changing vaccine for people like me with Lynch syndrome”.
“As passionate advocates for involving people with lived experience in research, we fully endorse the plans to reach out to the wider Lynch syndrome community to gather their views on a cancer-preventing vaccine. This is a crucial step in preparing for future clinical trials.”
Michelle Mitchell, Cancer Research UK’s Chief Executive comments that cancer vaccines “continue to show promise in helping to create a world where people can live longer, better lives, free from the fear of cancer”.
“Projects like LynchVax are a really important step forward into an exciting future, where cancers that occur in people with Lynch syndrome could potentially be prevented. This is one of many cancer vaccine projects Cancer Research UK is funding that we hope will reduce the number of cancer cases over the coming decades.”
To hear from experts working to address various cancers with vaccines, get your tickets to the Congress in Barcelona this October. Don’t forget to subscribe for more vaccine updates every week.
by Charlotte Kilpatrick | Sep 10, 2024 | Global Health |
A study in CMAJ in September 2024 evaluates the cost-effectiveness of different age cut-offs for RSV adult vaccination programmes, with or without a focus on people with higher disease risk. The authors compared alternative age-, medical risk-, and age- and medical risk-based policies. They found that, although all vaccination strategies “averted medically attended RSV disease”, universal age-based strategies were a less efficient use of resources than medical risk-based strategies.
The study
By May 2024, two RSV vaccines were approved for use in Canada in adults aged 60 years and older: RSVPreF3 and RSVpreF. The researchers performed a model-based cost-utility analysis of RSV vaccination programmes in the Canadian population aged 50 years and older. They developed a static individual-based model of medically attended RSV disease to consider the effects of various policies on RSV-associated outcomes. The model followed a multi-age closed population of 100,000 people over a 3-year period. Individuals were characterised by the presence or absence of 1 or more chronic medical conditions.
The authors evaluated a combination of age-only, medical risk-only, and age- plus medical risk-based single-dose vaccination strategies:
- Age-based: all people the same age or older than the specified age cut-off were eligible to receive the vaccine.
- Medical risk-based: only people aged greater than or equal to the specified age cut-off who also had 1 or more chronic medical conditions were eligible to receive the vaccine.
- Age- plus medical risk-based strategies: people were eligible to receive the vaccine if they met an age requirement, or if they were younger and had at least 1 chronic medical condition. A lower age bound was evaluated for these strategies.
Study results
Results were “not appreciably different” for the 2 vaccines evaluated. For both vaccines, a programme that focused on vaccinating people with at least 1 chronic medical condition aged 70 years and older was the “optimal” strategy for a cost-effectiveness threshold of $50,000 per quality-adjusted life year (QALY). Lowering the age recommendations to people with at least 1 chronic medical condition aged 60 years and older resulted in sequential incremental cost-effectiveness ratios (ICERs) of around $100,000 per QALY gained compared with a medical risk-based policy for those aged 70 years and older.
“Age-only strategies were never identified as cost-effective options regardless of the cost-effectiveness threshold used, when compared with other strategies.”
Vaccinating adults aged 80 years and older resulted in sequential ICERs of $3261-$5391 per QALY gained. Lowered age recommendations to 75 years and older required a cost-effectiveness threshold of approximately $80,000 per QALY.
Conclusions
The analysis highlights that the strategies that focussed on adults with underlying medical conditions putting them at increased risk of RSV disease are more likely to be cost-effective than general age-based strategies. Vaccination of older adults may be “less costly and more effective” than no vaccination, and vaccinating people aged 70 years and older with chronic medical conditions is “likely to be cost-effective”. Broader programmes may also be more cost-effective in settings with higher risk of disease and health care costs.
The authors conclude that RSV vaccination programmes have the potential to avert a substantial burden in older adults if appropriately targeted.
“RSV vaccination programmes in some groups of older Canadians are expected to be cost-effective, with programmes focusing on people with underlying medical conditions that place them at increased risk of severe RSV disease expected to provide the best value for money.”
For more on RSV vaccine development and strategies for adult immunisation programmes at the Congress in Barcelona, get your tickets now. Don’t forget to subscribe for weekly vaccine updates.
by Charlotte Kilpatrick | Sep 9, 2024 | Global Health |
The UK Department for Environment, Food, and Rural Affairs (DEFRA) announced in September 2024 that the Secretary of State has permitted the use of three unauthorised bluetongue serotype 3 (BTV-3) vaccines in the United Kingdom. The vaccines can be used with an appropriate licence; these will be geographically targeted general licenses or specific licences, granted through applications to the Animal Plant Health Agency (APHA). The vaccines are suppressive and do not prevent infection.
Bluetongue
The World Organisation for Animal Health (WOAH) states that bluetongue (BT) is a “non-contagious, viral disease” that affects domestic and wild ruminants. The virus is a member of the Reoviridae family; there are 24 identified serotypes with varying abilities to cause disease. Symptoms are “most severe” in sheep, resulting in deaths, weight loss, and disruption in wool growth. However, cattle “often have a higher infection rate than sheep”.
Vaccination
In August 2024, the UK’s Chief Veterinary Officer responded to a “rising number” of bluetongue cases in Europe with a call for “renewed vigilance and responsible sourcing of livestock”. After several confirmed cases of BTV3 in Norfolk, Suffolk, and Essex, the Chief Veterinary Officer declared a bluetongue restricted zone across the region. Now, farmers in England are encouraged to contact their veterinarians to discuss use of available BTV-3 vaccines.
While some authorised BTV vaccines, which target other BTV serotypes, the BTV-3 vaccines “reduce rather than prevent viraemia”. As this does not prevent animals from being infected or infectious, movement controls and trade restrictions apply to vaccinated animals. Commenting on the permission to use these vaccines, Biosecurity Minister Baroness Hayman emphasised that it forms “part of our efforts against this highly infectious disease”.
“We are working at pace in order to provide farmers with everything they need to protect their livestock and businesses and would recommend they contact their veterinarians for access to the vaccines. Farmers are also reminded that free testing remains available.”
Chief Veterinary Officer Dr Christine Middlemiss echoed this call for farmers to contact veterinarians and to “continue monitoring their animals frequently for clinical signs and report suspicion of disease to the Animal Plant Health Agency”.
“These vaccines are an important step forward and will aid in reducing clinical signs in animals and the impact of disease on farms, but it is not a protective vaccine, so we are still urging farmers to follow all of our guidance in order to prevent the disease spreading to their herds and any further.”
To discuss animal health and the role that vaccination strategies can play in protecting livelihoods and food security, do join us for the One Health and Veterinary Track in Barcelona this October, and don’t forget to subscribe to our weekly newsletters for more vaccine updates.
by Charlotte Kilpatrick | Sep 6, 2024 | Global Health |
The Vaccine Group (TVG) announced in September 2024 that its partnership with the University of Plymouth and the University of Cambridge has been awarded “significant” government funding to develop a vaccine to stop the development and spread of Streptococcus suis. Streptococcus suis is a bacterial infection that commonly affects the UK pig population. It can cause serious disease in pigs and has the potential to infect the humans working with them.
Streptococcus suis
Affecting more than 60% of pig farms across several countries in Europe, Streptococcus suis threatens both the pork industry and public health. It is a “noteworthy” pathogen responsible for significant bacterial mortality in piglets after weaning. There are no proven vaccines to address the disease’s “many strains”, and infected pigs are treated with different antibiotics.
The UK Government is targeting a 50% reduction in antibiotic use in livestock by 2030, so TVG is responding to the urgent demand for an effective vaccine. Their project will assess if a vaccine candidate that is already effective against the most common strain of the disease can protect pigs against multiple, or all, known strains. This has potential to also prevent transmission to humans.
DEFRA’s Farming Innovation Programme is providing a grant of over £1 million through Innovate UK. The project will unite experts from vaccine development, antimicrobial resistance, and veterinary medicine; it develops previous research that identified the potential candidate for the Streptococcus suis vaccine. Trials will be carried out with Moredun Scientific Ltd to explore the vaccine’s potential. The team will engage the pig farming community in their research to ensure that the vaccine meets requirements and can be administered in an “efficient and cost-effective manner”.
Dr Jeremy Salt, CEO at The Vaccine Group, described Streptococcus suis as a “major cause for concern” for farmers across the UK. It can lead to “significant losses”. Furthermore, as a zoonotic infection, it presents a risk of transmission to humans in the industry.
“Our goal in developing an effective vaccine is to stop the bacterial infection from developing in pigs and humans in the first place. By doing so, we can better protect the farmers, their animals, and their livelihoods.”
Dr Salt also hopes to make pork production “more efficient, human, and sustainable”, whilst helping the sector “address the global challenges of antibiotic resistance and carbon emissions”.
We look forward to welcoming Dr Salt back to the Congress in Barcelona to chair our One Health and Veterinary Track; get your tickets to join us there, and don’t forget to subscribe to our weekly newsletters for vaccine updates.
by Charlotte Kilpatrick | Sep 6, 2024 | Global Health |
WHO announced in September 2024 that the first phase of a polio vaccination campaign has been “successfully” completed in Gaza. Over 187,000 children under ten years were vaccinated with novel oral polio vaccine type 2 (nOPV2) in central Gaza between 1st and 3rd September. Coverage for this phase has exceeded the initial estimated target of 157,000 children, which WHO attributes to population movement towards central Gaza and expanded coverage in areas outside the humanitarian pause zone. Vaccination will continue at four large health facilities in central Gaza to ensure that no child is missed in the area.
First phase complete
The first phase was conducted by 513 teams, comprising more than 2180 health and community outreach workers. Vaccinations were offered at 143 fixed sites, including hospitals, medical points, primary care centres, camps where displaced people are living, key public gathering spaces, food and water distribution points, and transit routes. Mobile teams also visited tents and hard-to-reach areas to ensure families who were unable to attend fixed sites were able to access vaccines. Special missions to Al-Maghazi, Al-Bureij, and Al-Mussader were also needed to reach a “substantial number of children” who were eligible for vaccination but unable to reach vaccination sites.
Dr Richard Peeperkorn, WHO Representative for the occupied Palestinian territory described the completed first phase as “positive momentum”.
“It has been extremely encouraging to see thousands of children being able to access polio vaccines, with the support of their resilient families and courageous health workers, despite the deplorable conditions they have braved over the last 11 months.”
The next phases
The next phase of the campaign will be conducted in southern Gaza between 5th and 8th September, targeting an estimated 340,000 children under ten. This phase will involve 517 teams, including 384 mobile teams. Almost 300 community outreach workers have begun outreach to families in southern Gaza to raise awareness about the campaign. 490 vaccine carriers, 90 cold storage boxes, and additional supplies have been transferred to Khan Younis for distribution. The third and final phase of the campaign will be implemented in northern Gaza between 9th and 11th September, targeting around 150,000 children.
Dr Peeperkorn commented that the “successful delivery” of the first phase is a “culmination of immense coordination among various partners” and donors. It “underscores the importance of peace for the health and well-being of people in Gaza”.
“We call on all parties to continue fulfilling their commitment to the humanitarian pauses as the second phase of the campaign begins tomorrow.”
Each round of the campaign must achieve vaccine coverage of 90% of higher to stop the polio outbreak and reduce the risk of re-emergence “given the severely disrupted health, water, and sanitation systems in the Gaza Strip”. Coverage will be monitored throughout the campaign with the potential to extend vaccinations if needed to meet coverage targets.
For insights into developing effective vaccination strategies in emergency and routine situations do join us at the Congress in Barcelona this October and subscribe to our weekly newsletters here.
by Charlotte Kilpatrick | Sep 5, 2024 | Global Health |
Bavarian Nordic announced in September 2024 that the first doses of its mpox vaccine, MVA-BN (JYNNEOS), have arrived in the Democratic Republic of Congo (DRC) to support response efforts. Further shipments are planned within the next few days, contributing to a total of more than 250,000 doses donated by the European Commission’s Health Emergency Preparedness and Response Authority (HERA), the United States government, and Bavarian Nordic.
First doses arrive
This shipment brings the first mpox vaccines to the DRC, which Bavarian Nordic describes as a “turning point” in the joint efforts by Africa CDC and the international community. The DRC authorities have issued national emergency use authorisation for MVA-BN to allow immediate deployment. Broader deployment on the continent is “pending an emergency use listing” from WHO.
WHO Director-General Dr Tedros Adhanom Ghebreyesus shared his reaction to the delivery on social media, emphasising that WHO and partners are supporting DRC in the delivery of a “comprehensive health emergency response based on case finding, contact tracing, targeted vaccination, case management, and community engagement and mobilisation”.
“Once again, we are grateful to the European Union for its solidarity and for sharing vaccines.”
Responding to the call
DRC is the “epicentre” of the African mpox outbreak, reporting more than 94% of reported cases and nearly 99% of the reported deaths year-to-date on the continent. Although surveillance and control are “continuously improving” the true burden of disease remains unclear as case numbers are “underreported”. Bavarian Nordic’s President and Chief Executive Officer, Paul Chaplin commented on the “alarming rate” of increased cases in the DRC, where “aid is desperately needed”.
“Africa CDC has called for the international community to step up and mobilise the resources needed to combat the outbreak, and we are proudly responding to this call together with our partners in the European Commission’s Health Emergency Preparedness and Response Authority and the U.S. government, who have demonstrated strong leadership and determination during this serious health crisis.”
Mr Chaplin stated that “time is of the essence” but is pleased that “the way has now been paved for our mpox vaccines to reach the people in the DRC who are most in need”.
“We will continue our collaborative efforts with both international partners and local authorities to further broaden access to our vaccine in the region.”
While this news is welcomed by public health experts, will the doses be enough to control the outbreak, and is there a risk of perpetuating dependence on donations? For more on preparedness and response efforts at the Congress in Barcelona this October, get your tickets now. Don’t forget to subscribe to our weekly newsletters here.
by Charlotte Kilpatrick | Sep 5, 2024 | Global Health |
In response to the mpox outbreak, declared a PHEIC by WHO and a PHECS by Africa CDC, the two organisations announced that they are co-leading a “coordinated, continent-wide response”. The Mpox Continental Preparedness and Response Plan for Africa describes “essential priorities” to control the current outbreak, focusing on ten pillars. The plan categorises Member States into four risk-based groups to ensure efforts and resource allocation are targeted. The estimated budget for September 2024 to February 2025, excluding the cost of vaccines, is US$599,153,498
Collective commitment
In the foreword by Africa CDC Director General Dr Jean Kaseya and WHO Africa Regional Director Dr Matshidiso Moeti, the declaration of mpox as a PHECS is described as a “bold move”. This was followed by WHO’s declaration, reflecting “alignment” and “collective commitment to raising awareness, mobilising resources, and galvanising action at all levels”. Drs Kaseya and Moeti state that current “battle” against mpox has been shaped by “hard-earned lessons” from the COVID-19 pandemic.
“The experience of COVID-19 exposed vulnerabilities in our health systems, showed Africa’s inequity and unfair treatment in terms of access to medical countermeasures, highlighted the urgent need for enhanced preparedness, and underscored the importance of swift, coordinated action in the face of emerging health threats.”
The “foundation” of the mpox response is built on lessons of “solidarity, resilience, and collaboration”.
4-ONE
A new approach is outlined: a “4-ONE APPROACH”:
- ONE coordination mechanism
- ONE continental response plan
- ONE budget
- ONE monitoring and evaluation mechanism
Africa CDC and WHO will lead efforts to implement the “unified approach” with global and continental stakeholders. The plan is a “roadmap” to facilitate a “coordinated, comprehensive, and evidence-based response” that puts the principles of “equity, inclusivity, and accountability” at the centre.
“As we move forward, we are guided by our strong commitment to protecting the health of all Africans, enhancing our collective resilience, and securing a healthier future for our continent. Together, we will overcome this challenge and build a stronger and resilient Africa.”
Mpox: then and now
Mpox was first described in the Democratic Republic of Congo (DRC) in 1970. It is a viral zoonotic illness that has caused “numerous outbreaks” since its identification. Although early outbreaks tended to be associated with zoonotic transmission from wildlife to humans, recent cases in urban settings have suggested changes in transmission dynamics.
“The emergence of zoonotic diseases is driven by complex ecological, climatic, political, economic, security, and social factors, some of which are becoming further exacerbated on the continent.”
However, the “warning signs” of local outbreaks are often “neglected” with “limited investigation, surveillance, diagnosis, and response”. Despite improvements in surveillance and reporting systems to enhance the understanding of mpox’s epidemiological patterns, “significant gaps” remain. Mpox virus has two variants: clade I and clade II. Clade I is geographically concentrated around the Central and Eastern Africa region and is considered “more virulent”; Clade II is found in Western Africa and other regions.
In the global outbreak of 2022-2023, the disease spread drew “renewed focus” on medical countermeasures. While many countries outside Africa were “quick to respond”, Africa faced “significant challenges in accessing these crucial tools”. Despite the high burden of mpox in several countries in Africa, access to vaccines and other medical countermeasures was inequitable.
“This lack of access was due to multiple factors, including limited global production capacity, unequal distribution agreements, and a lack of investment in public health infrastructure in Africa.”
Vaccines like JYNNEOS (MVA-BN) and ACAM2000 were widely authorised for emergency use but were “largely unavailable to African countries”. The authors of the plan attribute this to pre-existing contracts between manufacturers and high-income countries. Furthermore, logistical challenges exacerbated the disparity; “inadequate” cold chain storage facilities and distribution networks” created obstacles to the delivery of countermeasures.
“This inequity underscored the urgent need for Africa to develop self-reliance in manufacturing and distributing medical countermeasures to avoid similar scenarios.”
The current situation is concerning; reported cases are increasing in number across the continent. In comparison with 2022, there was a 79% increase in reported cases in 2023. By 3rd September 2024, confirmed cases have exceeded the number reported in 2023 by over 3,700. Furthermore, the recent outbreak has “dramatically” affect children under 15 years (60%). In 2024, 13 countries have reported cases, with a new subvariant of mpox clade I (clade Ib) identified since September 2023. This has been ‘widely circulating” among commercial sex workers and their sexual contacts.
While the increasing cases are worrying, the “true burden” is uncertain. Thus, the authors demand enhanced surveillance and detection. They also highlight the need for vaccination of both targeted and expanded priority population groups, particularly in the context of Africa’s “weaker surveillance systems and limited diagnostic capacity”.
“The Mpox Continental Preparedness and Response Plan for Africa (MCPRPA) seeks to build a stronger foundation for health security in Africa through a country-driven unified approach, prioritising prevention, enhancing immunity at community level, and promoting the continent’s self-reliance.”
Risk categories
The plan classifies African Union Member States according to their mpox status and risk level. The risk level is for “planning and resource optimisation”.
- Experiencing sustained human-to-human transmission: DRC, Burundi, Nigeria, South Africa, Côte d’Ivoire, Central Africa Republic
- Not already falling into category 1 but experiencing sporadic human cases since 1st January 2022 and/or countries that are assessed as having endemic zoonotic reservoirs for mpox: Rwanda, Kenya, Uganda, Sierra Leone, Libera, Ghana, Cameroon, Gabon, Republic of Congo, Morocco, Egypt, Benin, Mozambique, Sudan
- Not already falling into the first two categories that are assessed as requiring readiness including due to proximity to category 1 countries by land, air, or sea: Angola, Zambia, Eswatini, Lesotho, Ethiopia, South Sudan, Tanzania, Malawi, Republic of Guinea
- All other countries
Guiding principles
The plan relies on guiding principles from lessons learnt during the COVID-19 pandemic; the align with the 2023 Lusaka Agenda, which emphasises “strengthening joint approaches for achieving equity in health outcomes, operational coherence, and a coordinate approach to product development and research”.
- Country-driven: The plan focuses on mpox preparedness and response interventions based on priorities identified by affected countries to ensure that the response is tailored to the needs of each country.
- Science-driven: The strategic approaches and key interventions are grounded in the best available scientific evidence, ensuring that the response is effective and adaptive to the evolving understanding of the virus and its transmission.
- Equity and solidarity: Prioritisation of issues and resource allocation should be sensitive to the needs of the most affected regions/provinces, vulnerable groups, and countries most in need. This is supported by global solidarity, ensuring that medical countermeasures are made available to African Member States equitably.
- Unified: Align all partners around a single cohesive plan, ensuring that all stakeholders work toward common objectives, minimising duplication and maximising impact.
- Single collaboration mechanisms: Streamline efforts through coordinated leadership.
- Sustainability: Focus on developing sustainable, long-term solutions that can be scaled and maintained over time, ensuring that countries are better prepared for future outbreaks and that response efforts have a lasting impact.
10 pillars
The plan has 10 pillars, each with a strategic objective and actions.
- Coordination and leadership
- Strategic objective – establish one functional coordination mechanism with one team, one plan, one budget, and one monitoring and evaluation (M&E) framework at continental, national, and subnational levels.
- Actions – enhance harmonised coordination and collaboration between relevant stakeholders including resource mobilisation.
- Risk communication and community engagement (RCCE)
- Strategic objective – support and engage communities, particularly the most vulnerable members, so that they practice key public health recommendations and access the needed services to reduce transmission, morbidity, mortality, and secondary impacts.
- Actions – engage communities in public health response and ensure their perspective and realities drive the mpox response interventions.
- Surveillance
- Strategic objective – establish/enhance functional event-, community-based-, and cross-border mpox surveillance systems at continental, national, subnational levels.
- Actions – strengthen mpox surveillance through event/community-based surveillance, contact tracing, point of entry, and cross-border information sharing.
- Laboratory capacity
- Strategic objective – strengthen mpox laboratory testing and sequencing capacity to confirm at least 80% of suspected mpox cases and sequence at least 5% of epidemiologic and geographic representative confirmed mpox cases.
- Actions – strengthen laboratory testing for diagnostic and sequencing through training and provision of equipment and reagents.
- Case management
- Strategic objective – support comprehensive case management for mpox, including medical, nutritional, and psychosocial care, to reduce the case fatality rate to below 1% (0.5%).
- Actions – strengthen case management for mpox.
- Infection prevention and control
- Strategic objective – strengthen infection prevention and control measures at 80% of health facilities and schools in hotspots of mpox-affected and at-risk Member States to minimise the risk of mpox transmission.
- Actions – strengthen infection and prevention control measures at households, schools, health facilities, and communities.
- Vaccination
- Strategic objective – support the administration of mpox vaccination to 80% of the targeted population.
- Actions – vaccination of targeted and expanded high-risk population groups is a proactive measure to address the delayed responses that can occur due to weaker health systems, weaker surveillance systems, and limited diagnostic capacity. This would build population resilience, reduce the public health impact of mpox, and prevent healthcare systems from becoming overwhelmed. Mpox vaccination will be implemented in two phases. In the first phase, vaccines will be administered to the exposed group of contacts and the contacts of contacts and the expanded group of those at risk. In the second phase, consideration could be given for affected communities, depending on progress in epidemiology and vaccine availability.
- Research and innovation
- Strategic objective – coordinate and conduct mpox operational and clinical research across the continent to address critical knowledge gaps and support response efforts, and coordinate and enhance research and development (R&D) for the manufacturing of countermeasures to ensure rapid deployment during outbreaks.
- Operations support and logistics
- Strategic objective – provide robust operational support, ensuring the safety and security of response staff, maintaining key infrastructure and ensuring the efficient procurement and distribution of essential supplies.
- Actions – ensure robust support by developing standards for mpox supplies, coordinating demand forecasts, enhancing supply transparency and implementing fair allocation, strengthening logistics, and maintaining supply chain integrity for equitable distribution.
- Continuity of essential services
- Strategic objective – advocate for and support Member States to monitor the implementation of basic services ensuring continuity to avert loss of gains.
Budget
The plan also details “key resource requirements” for the first six months of operations. The estimates assume an initial case load of 2,000 cases per week, which increases to 4,000 cases per week in the first two months of operations. This is expected to continue through the fourth month, after which cases might decrease. The total estimated number of suspected cases is 92,000 over the first six months. Vaccine procurement costs are excluded from budget estimates as these depend on the outcome of “ongoing negotiations” with manufacturers.
The overall estimated budget for the six-month plan is US$599,153,498. Of this, 53% (US$315,311,463) are assigned to mpox outbreak response effort in the 13 affected Member States. 2% (US$14,000,000) will support the 15 high risk, non-affect Member States with emergency preparedness and 45% (US$269,842,035) will go toward partners’ operational and technical support.
Monitoring and evaluation
The monitoring and evaluation of the plan are centred on a results-based management approach, ensuring capture and analysis of key performance results information and dissemination for management decision-making, reporting, and stakeholder use.
- Input and output monitoring will be ensured through reporting tools developed by the incident management system (IMS). Periodic and ad-hoc joint support supervision visits will take place and internal review mechanisms will be used to ensure the correctness, completeness, and timeliness of monitoring data.
- The Continental incident management team (IMT) will conduct periodic evaluations of the plan.
- Data collection will be shared with the Continental IMT, which has the primary mandate for its monitoring.
Will this approach be sufficient to control the outbreak and establish mechanisms for future health threats on the continent? For expert insights into equitable vaccine development and deployment, get your tickets to join us at the Congress in Barcelona this October, and don’t forget to subscribe to our weekly newsletters here.
by Charlotte Kilpatrick | Sep 4, 2024 | Global Health |
A study in Vaccine in August 2024 explores the role of “structural and historical inequities” in shaping access to COVID-19 vaccines for the transgender and gender-diverse (TGD) and disability communities in the Indian context. The authors take a participatory qualitative research approach, interviewing 45 individuals from the two communities and “other key stakeholders and health system representatives”. This process revealed several structural barriers, including information and communication gaps and barriers relating to transport and infrastructure. These gaps had “parallels in past health systems experiences”, indicating “longstanding and pervasive inequities” in health and allied systems. The paper highlights the need for avenues of “cross-movement advocacy and solidarity” as well as health system reforms.
COVID-19 vaccination
India initiated the “world’s largest” national COVID-19 vaccination programme in January 2021, delivering 2.2 billion doses of the COVID-19 vaccines by 2023. Although India’s vaccine acceptance rate “stands higher” than some high-income countries, there is a disparity between coverage in the “general population” and trans and gender diverse persons (TGD) and the disability community. In May 2021, around 11.7% of the general population was vaccinated but coverage was 5.22% for the TGD community. By November 2021, the rate was approximately 0.03% within the disability community.
“In India, the TGD and disability communities both face a higher risk of neglect, violence, and lack of family support. This, combined with stigma and discrimination, marginalises both communities, socio-economically and within the health system.”
These communities have higher rates of unemployment, lack of education, and poverty. Many people are dependent on “precarious employments” such as begging and sex work. Due to “poorer immune status” associated with disability, co-existing HIV infections, or poorer health in general, both communities faced greater risk of COVID-19-related mortality necessitating early vaccination. In the Indian context, both communities have legal protections. However, prioritisation of these communities for vaccination “lagged”, due to a “diverse set of factors at the individual, community, institutional, and policy levels”.
“Studies suggest that under vaccination in the disability community stemmed from systemic exclusion, attributed to lack of access, non-prioritisation, and anticipated social stigma. In the transgender community, negative past experiences and fear of getting traumatised had led community members to avoid visiting healthcare facilities.”
The authors infer that “structural ableism and trans-negativity”, along with “historical marginalisation”, play a central role in vaccine hesitancy for both communities. Barriers are described at individual, community, institutional, and policy levels:
- Individual – trust in systems involved in vaccination is tied to past experiences with vaccination and health systems. Concerns also arise about the potential adverse effects of vaccines on health needs and disabilities.
- Community – misinformation was reported among the TGD community, particularly the Hijra community, with many fearing that the vaccines would have a negative effect. “Inadequate” inclusion in clinical trials and a “dearth of information” on the effect of vaccines on different disabilities and gender-affirming interventions led to unaddressed concerns, delaying uptake.
- Institutional – clear ableism is identified in the design of vaccination programmes, from inaccessibility of vaccine-related information to vaccination centres. For the TGD community, the need for legal ID cards “posed a challenge”. Vaccination was also inaccessible and unaffordable, leading to reduced motivation for getting vaccinated.
- Policy – there no immediate government guidelines for vaccinating the two communities when the rollout began in January 2021. Later initiatives sought to address the inaccessibility of the appointment booking portal COVID Vaccine Intelligence Network (CoWIN). In May 2021, guidelines were released for the vaccination of persons without any prescribed ID proof.
“The health system’s approach in response needs to engage with these social determinants of vaccination and needs to go beyond hesitancy to focus on vaccine equity for marginalised communities.”
The study
The investigation involved a community-based participatory research approach (CBPR), engaging participants as partners. The setting was pan-India, drawing participants from 19 states, covering both urban and rural areas. In-depth and key information interviews were conducted to collect data:
- In-depth interviews (IDI) were planned with people living in India, above 18 years, self-identifying as transgender, gender non-binary, gender non-conforming, gender fluid, or identifying with a socio-cultural transgender identity such as hijra, kinnar, or aravani, and/or as a person with a disability.
- Key informant interviews (KII) were planned with other key stakeholders such as vaccine advocates, vaccine programme managers, media professionals, and vaccine providers.
Virtual interviews took place on Zoom, WhatsApp, or by telephone to ensure accessibility, lasting between 1 and 2 hours.
Four themes
Most participants from the TGD and disability communities reported motivation to get COVID-19 vaccines, but the “journey to immunisation” revealed a range of barriers in the process of deciding to get vaccinated and accessing vaccination. The authors identify four themes that reflect how the participants navigated structural inequities: information and communication barriers, procedural barriers, infrastructure barriers, and service provision barriers.
“While some barriers were distinct for both the communities, parallels in experiences provide a cross-movement platform for reflecting on the exclusivity of vaccination and health systems.”
Information and communication
Concerns were expressed about adverse effects with respect to specific needs. This was shaped by lack of information on the interaction of COVID-19 vaccines and gender-affirming care or HIV treatment. A lack of clarity caused confusion and fear for many respondents. Participants with physical disabilities and blood disorders conveyed concern about vaccines in relation to their disabilities, influenced by a fear of adverse effects that could potentially exacerbate their disabilities. On the other hand, a wheelchair user who got polio because she didn’t get the polio vaccine, expressed confidence in vaccination because of this experience.
Participants also attributed their anxieties about potential adverse effects to “systemic gaps in vaccine research communication and information dissemination”. Indeed, a lack of targeted vaccination communication for the disability community demonstrated a “structural neglect” of the community’s needs. Previous experiences with the health care system also reflected the “information inequity”. Thus, the omission of both communities within COVID-19 vaccination “exists within the context of a longstanding history of neglect”.
Process
CoWIN, the online vaccination appointment registration system introduced by the government in the pandemic, posed “certain challenges for vaccine registration”. High demand made it difficult to find a slot and led to frequent portal crashes. Participants with visual impairment, intellectual disability, and cerebral palsy reported that the need for “speedy action” made it challenging to book a slot. This exaggerated dependence on caregivers and non-governmental organisations (NGOs) for bookings. The Aarogya Setu application, which provided COVID-19-related information, and other digital apps for medical service access, were hard to access. This highlights “systemic patterns of digital inaccessibility for community”.
CoWIN also collected data on gender, providing only three categories: “male”, “female”, and “others”. The “others” category was introduced in the Indian Census of 2011 and has been consolidated by the Supreme Court of India’s “pivotal judgement” in 2014, which gave TGD persons a legal right to identify as male, female, or “third gender”. However, participants raise concerns that the gap in data collection is an “impediment for community members to advocate for equity”. The portal posed no question about disability.
The requirement of identity documentation created a barrier to access for the TGD community in a “unique and pronounced manner”. For example, many in the Hijra community did not have their documents, or had gender-discordant identity cards, which created discomfort and apprehension about unnecessary scrutiny. Demonstrating this, one participant was denied a second dose because the name and sex assigned at birth on their first dose vaccination certificate conflicted with their new Aadhaar card. Although the Central Government eventually confirmed that an Aadhaar card was not mandatory for vaccination, many centres maintained its importance.
“This not only invisibilises and stigmatises TGD experiences but also pits the right to self-determination against the right to access healthcare services, highlighting the marginal status of TGD persons and transgender rights in the government’s register.”
Transport and infrastructure
Once participants had decided to take a vaccine, participants encountered several challenges in reaching the vaccination centre. Some participants from the disability community reported travelling 20-30km to reach vaccination centre. They also identified a lack of accessible transport, particularly during lockdown periods. Regions with hilly terrain made it hard to implement disability-friendly infrastructure. Both communities reported that arranging transport was “challenging”, especially in rural areas.
Vaccination centres “embodied infrastructural inaccessibility in various forms”. For example, TGD persons faced challenges through “infrastructure shaped by gender binary orthodoxy”. Queues and washrooms were divided into men’s and women’s, affecting participants’ service experiences. This signalled “neglect and cis-binary-normativity” and forced “trade-offs between asserting their identity in that space and safely and seamlessly receiving their vaccination”. The physical accessibility of vaccination centres presented “wide-ranging challenges” to the disability community such as a lack of accessible parking or a requirement to stand in line.
Despite the existence of ‘Har Ghar Dastak’ (door-to-door vaccination), participants faced difficulties in accessing this programme. For the few who secured this, the process demanded “long and persistent efforts”. Many faced unresponsive providers, meaning they were left partially vaccinated despite being willing.
Mistreatment
Participants from both communities reported a range of “stigmatising and discriminatory experiences” from staff at vaccination centres. One TGD participant was denied entry, despite going through a community-led NGO. One scheduled caste participant with cerebral palsy faced caste-based discrimination and was denied entry to the hospital, even after sharing insight into his disability. Some participants with disabilities also shared that vaccine providers hugged them and took photos with them without gaining consent; this was viewed as “not only tokenistic but putting them at risk”.
“This points to the ableism in vaccination systems where disability inclusion is not seen as a matter of justice and enabling of rights but that of charity and patronising.”
Participants from both communities tried to ensure a safe, scrutiny-free experience through various strategies. These included presenting as cisgender or hiding a disability. Another approach was using a trusted contact, going through a group, or being accompanied by someone they trust as a “protective buffer”. These “self-preservation strategies” highlight the inequities that “predated and pervaded” COVID-19 vaccination. Many of these strategies emerged from anxieties that are rooted in “histories of exclusion and neglect”.
“Past experiences of inaccessibility, stigma, discrimination, harassment, medical negligence, and denial of services, within and outside the healthcare system, were commonplace.”
Some participants did comment their experiences of NGO and government-led initiatives that centred their needs. For example, government departments made efforts to establish vaccination drives for the transgender community in Kerala and for the disability community in Nagaland. Some NGOs and community leaders also engaged with these communities to “inform and counsel them on vaccination”. One NGO arranged home vaccinations in institutional settings with people with disabilities, and camps were established in Maharashtra to cater to the work schedules of the transgender and sex worker communities.
At many of these centres, staff were “sensitised”, and doctors worked with community leaders to build trust in the process. These accounts highlight the positive effects that government, NGO, and community partnerships can have for service users.
“Beyond access, an affirming, stigma free vaccination experience is a pillar of vaccine equity.”
Conclusion and comments
The researchers identify an “urgent need to reframe conversations” about vaccine hesitancy, emphasising inequities and structural gaps. They call for a paradigm shift to a “systems accountability approach”.
A member of the Disability Rights Alliance, Meenakshi B., filed a PIL in 2021 for better vaccine access for persons with disabilities and is quoted in The Hindu reflecting on the challenging experience of accessing COVID-19 vaccinations: “there were multiple barriers”. The barriers included lack of accessibility at vaccine centres and information. Indeed, although the centre released guidelines on providing care to persons with disabilities, “this was not met”.
Distinguished Professor of Public Health, Public Health Foundation of India, K Srinath Reddy, demands a system where outreach care is provided.
“Public health functionaries have to go to the person where necessary – the system has to initiate contact, rather than waiting for the person to come to the facility.”
This approach has benefits for vaccine safety monitoring as well. However, “this hardly exists in our urban healthcare scenario”. Professor Reddy also commented on the importance of engaging a “diverse set of people” in clinical trials.
“It is only when the trial is diverse that the health system can understand where problems and limitations lie and where special services may be required.”
The importance of encouraging diversity in vaccine research and development, as well as the need to engage diverse groups in vaccine communication strategies, return to the Congress agenda in Barcelona this October. To participate in these discussions, get your tickets here, and don’t forget to subscribe to our weekly newsletters for more vaccine updates.
by Charlotte Kilpatrick | Sep 3, 2024 | Global Health |
A study in Vaccine X presents a “comprehensive view of people’s opinions, fears, and behaviours” about mpox. The authors searched various sites for descriptive cross-sectional study designs from 2022 and 2023 addressing “knowledge, attitude, perception, preparedness, willingness to get vaccinated, and practices” against mpox infection. They conclude that there is a need to increase knowledge about mpox and spread awareness on the importance of preventive measures like vaccination.
Awareness, attitudes, and actions
“The public’s response to an epidemic is influenced by each person’s perceptions of the illness and their ability to change their behaviour as conditions change.”
The paper describes prevention and treatment of mpox as “challenging” in areas where it is endemic. Prevention measures include isolation and immunisation, with WHO recommending the use of MVA-BN or LC16 vaccines, or the ACAM2000 vaccine “when the others are not available”. Further preventive actions require “good understanding of the nature of the virus”. For example, environmental surveillance can identify the spread of pathogens within societies, shedding light on possible pathways of transmission.
A key challenge in controlling the spread of Mpox is a lack of knowledge in healthcare workers (HCWs).
“Therefore, there must be good awareness and appropriate attitudes and actions toward mpox among the HCWs and the general population.”
The study
The study was intended to provide an overview of “knowledge, attitudes, willingness to get vaccinated, level of awareness, worry, and perception of risk” among different populations. The researchers searched several databases in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Eligibility criteria included studies in any language, descriptive cross-sectional study designs conducted in 2022 and 2023, and studies addressing knowledge, attitude, perception, preparedness, willingness to get vaccinated, and practices against mpox infection. Studies measuring these outcomes were included through validated questionnaires. An overall score was calculated to determine the knowledge, attitude, perception, preparedness, worries, and practices as well as willingness to get vaccinated.
The search resulted in a total of 493 articles, reduced to 289 after the exclusion of duplicates. 37 articles were included in full-text screening, resulting in 30 eligible articles for the systematic review and meta-analysis. These were cross-sectional studies featuring healthcare workers (14), general population (10), medical students (4), and university students in different specialities (2).
Findings
The authors describe knowledge of the disease, attitudes to prevention, and intentions to follow advised practices as “major determinants” of the adoption of preventive measures. For many diseases for which vaccines currently exist, higher vaccination rates are “very important” to generate higher immunity rates. To create necessary demand, the authors highlight the need to develop safe and effective vaccines but also to “ensure that the necessary logistical issues, equitable distribution, and the population acceptance are addressed”.
The results show that “less than half had good knowledge, while the majority had good attitudes toward mpox”. Most respondents were willing to take the mpox vaccine, and the majority were reported to be aware of mpox. Less than half had worries and perception of risk toward mpox, and knowledge was highest in the general population, followed by HCWs. However, HCWs were the “most willing population” to be vaccinated against mpox.
Different characteristics had influences on knowledge about mpox but not always to the same effect; for example, “gender may have an impact on knowledge levels, but the direction of that influence may be determined by other factors, such as cultural or societal standards”. Although some studies suggested that “higher education levels and certain professional backgrounds were related with more knowledge”, professional experience was not always associated with high knowledge levels.
65% of participants expressed willingness to get vaccinated, which “can’t be considered a high percentage” as herd immunity demands more than 80% of population vaccination. A study that reported only 8.8% willingness for vaccination attributed this to “inadequate levels of factual knowledge”. Factors associated with not getting vaccinated were “various” including gender, age, income level, and education level.
Less than half of the participants were reported to be worried about mpox (42.7%), but one study found 33.2% of participants were more about mpox than COVID-19. Another study reported that male HCWs were “less worried” about mpox than females, medical students were “significantly more worried” compared to other participants, and HCWs who had experienced COVID-19 infection were “significantly less worried” about the mpox outbreak.
Conclusion
The paper concludes that mpox knowledge should be increased through awareness campaigns and social media. The importance of advice to take mpox vaccines is also highlighted, with a focus on vaccine efforts in “vulnerable groups”.
“If adequate management and prevention strategies are implemented in the early steps, the virus will be controlled adequately.”
After the declaration of mpox as a PHEIC in August 2024, how might these attitudes change? Do you think the study can be used to inform public awareness campaigns and vaccination drives? For more on encouraging vaccine confidence at the Congress in Barcelona this October get your tickets here, and don’t forget to subscribe to our weekly newsletters for the latest vaccine updates.
by Charlotte Kilpatrick | Sep 2, 2024 | Global Health |
In August 2024 researchers at Weill Cornell Medicine shared that their strategy to provide protection against HIV has shown promise in a study. The paper in Science Immunology (not open access) explores the potential of a multidose immunisation regimen in infant rhesus macaques. Six vaccinations, containing a modified surface protein, stimulated “initial steps of a potent immune response”. The authors hope that a childhood immunisation approach could provide protection before the risk of contracting HIV “dramatically increases in adolescence”.
HIV in adolescents
HIV “predominantly” infects CD4 T cells, putting individuals at risk of “opportunistic diseases”. Infection can be fatal without lifelong treatment. UNICEF data reveal that adolescents and young people are a “growing share” of people living with HIV. Indeed, in 2023, 140,000 adolescents between the ages of 15 and 19 were newly infected with HIV. If this trend continues, UNICEF estimates that there will be around 183,000 new HIV infections among adolescents in 2030.
Risk factors and immunity
Dr Sallie Permar, Nancy C. Paduano Professor in Paediatrics and Chair of the Department of Paediatrics at Weill Cornell Medicine highlights the logic of immunising children, rather than adults. Not only do risk factors for HIV infection rise “steeply” as adolescents become sexually active, but evidence shows that infants and children are able to mount more effective immune responses to the virus than adults.
“One of the advancements we’ve made is to demonstrate that an HIV vaccine could be delivered on a schedule similar to routine vaccines already given to babies and children.”
An experimental vaccine
Vaccine research is looking for ways to stimulate broadly neutralising antibodies before exposure to the virus. In the latest study, the researchers used an experimental vaccine that had been developed from spike proteins on the envelope of HIV particles. Dr John Moore, professor of microbiology and immunology, and Dr Rogier Sanders, adjunct associate professor of research in microbiology and immunology, set out to “improve” the vaccine by altering the viral protein. The changes targeted a specific set of antibody-producing B cells, which provide protection for CD4 T cells. First author Dr Ashley Nelson, assistant professor of immunology research in paediatrics, commented on the importance of engaging the “right set” of B cells to generate a broadly protective response.
“We discovered that introducing certain mutations into the envelope protein could accomplish that in the setting of a naïve immune system.”
The study
The team administered the modified vaccine to five infant rhesus macaques in three priming doses; the first was administered less than a week after birth. This was followed by three doses of the vaccine matching the original HIV envelope protein. The final dose was given when the animals reached 78 weeks old; this is “roughly” equivalent to four or five years old in humans. Five animals also received all six doses of the original envelope protein vaccine as a control.
Three of the five animals who received the modified vaccine developed antibodies that “appeared to be precursors” to the broadly neutralising response. Investigations revealed that these antibodies attacked the site that the virus uses to invade CD4 T cells. However, they were not “fully effective against the same breadth of HIV strains” as “mature” broadly neutralising antibodies. One animal showed signs of developing this mature response.
Dr Nelson recognised that, although exposure to the modified protein “got the immune response started off in the right direction”, the “full potential” was achieved with booster shots containing the original version.
“We still need to identify the right combination of viral proteins to get us further down that path, starting from the earliest stages in life when multi-dose vaccines are commonly given.”
For more on innovative vaccine strategies and the latest vaccine developments at the Congress in Barcelona this October get your tickets here, and don’t forget to subscribe to our weekly newsletters here.
by Charlotte Kilpatrick | Sep 2, 2024 | Global Health |
In August 2024 the UK Department for Environment, Food, and Rural Affairs (DEFRA) announced the launch of a new tuberculosis (TB) eradication strategy to end the badger cull and “drive down” bovine Tuberculosis rates. TB has had a “devastating” effect on British livestock and wildlife in the past decade; over 278,000 cattle have been compulsorily slaughtered, and over 230,000 badgers have been killed. The cost to the taxpayer has exceeded £100 million each year. However, the Government is now introducing a new bovine TB eradication strategy in collaboration with farmers, vets, scientists, and conservationists to “rapidly strengthen and deploy a range of disease control measures”.
The strategy
DEFRA describes the new strategy as a “significant step-change” to the approach, using a data-led and scientific approach to end the badger cull by the end of this parliament. The approach includes:
- The first badger population survey in over a decade – the Government will work “at pace” to launch a new survey this winter to estimate badger abundance and population recovery to illustrate the effect of widespread culling over the past decade.
- A new national wildlife surveillance programme – after a decade of culling, the prevalence of TB in remaining badger populations is “largely unknown”. A surveillance programme will offer an updated understanding of disease in badgers and other wildlife to “unlock a data-driven approach” to inform the deployment of vaccines and other eradication measures.
- A new Badger Vaccinator Field Force – badger vaccinations create “progressively healthier badger populations” that are less susceptible to catching and transmitting TB. The Badger Vaccinator Field Force will increase badger vaccination to drive down TB rates and protect badgers.
- A badger vaccination study – to supplement the Field Force, a rapid analysis of the effect of badger vaccination on the incidence of TB in cattle will encourage farmers to participate and provide greater confidence in the approach.
Further information about animal and herd-level bTB risk will also be published on ibTB, an interactive map that enables cattle farmers and vets to understand the level of bovine TB in specific regions and manage risks accordingly.
Cattle vaccine development
DEFRA is also going to accelerate work on cattle vaccine development, which is “at the forefront of innovative solutions to help eradicate this disease”. The next stage in field trials is to start in the coming months, with the aim of delivering an effective cattle vaccination strategy in a few years and achieving officially TB free (OTF) status for England.
No more devastation
Daniel Zeichner, Minister for Food Security and Rural Affairs, stated that bovine tuberculosis has “devastated British farmers and wildlife for far too long”.
“It has placed dreadful hardship and stress on farmers who continue to suffer the loss of valued herds and has taken a terrible toll on our badger populations. No more.”
The eradication “package” will allow the end of the badger cull and “stop the spread of this horrific disease”. Chief Veterinary Officer Dr Christine Middlemiss agreed that bovine tuberculosis is “one of the most difficult and prolonged animal disease challenges” that causes “devastation for farming communities”.
“There is no single way to combat it, and a refreshed strategy will continue to be led by the very best scientific and epidemiological evidence. With the disease on a downward trajectory, we are at a crucial point.”
Dr Middlemiss highlighted the importance of collaboration to achieve the target of eradicating bovine tuberculosis in England by 2038. John Cross, Chair of the bTB Partnership, is “delighted” to hear the intention to “refresh” the strategy.
“The time is right to look again at the tools we use to tackle this persistent disease. Bovine is the common enemy, not farmers or wildlife groups. Only by working together, we will reach our goal.”
Responses to the announcement
Professor Malcom Bennett, Professor of Zoonotic and Emerging Disease at the University of Nottingham believes a review of bovine TB control in England is “good news for everyone”, particularly the pursuit of a “better understanding of the role of various host populations”. However, “many other important questions remain unanswered”, including diagnostic approaches in cattle and other hosts, and how they can be interpreted in different situations.
“For policy, there may be lessons to be learnt from COVID as well, for example in comparing the costs (in terms of human, animal, and environmental health as well as economics) of the disease with those of the various control options, and how one size policies (in this case, different host species in different places and environmental contexts) might not fit all.”
Professor Bennett suggested that an “open debate” would be “useful, even if we don’t all agree with its outcome”. Indeed, “more openness” would be “welcome”, particularly regarding badger population data. Professor Lord John Krebs, Emeritus Professor of Zoology, University of Oxford, commented that the recognition that culling is “not going to eradicate bovine TB” is a “welcome shift in policy”. Furthermore, the accelerated development of an effective cattle vaccine will “provide a long-term solution”.
“An important missing piece in the press release describing the new strategy is an explicit plan to use more sensitive tests for TB in cattle to help eliminate the hidden reservoir of infection in cattle.”
Ecology consultant Tom Langton took a critical view of the strategy, warning that “DEFRA has fallen behind the level of activity” to achieve targets and would impose changes “with limited visible stakeholder of public engagement”.
“We trust this process will not rush ahead and involve proper stakeholder engagement and not the secret DEFRA committees of the past.”
To participate in discussions about the role of vaccines in animal health efforts, why not get your tickets to join us at the Congress in Barcelona this October? Don’t forget to subscribe to our weekly newsletters here.
by Charlotte Kilpatrick | Sep 2, 2024 | Global Health |
UNICEF announced in August 2024 that it has issued an emergency tender for the procurement of mpox vaccines amid the public health emergency declared by Africa CDC and WHO. UNICEF is the world’s largest single vaccine buyer, reportedly procuring “more than 2 billion” doses annually for routine child immunisation and outbreak response on behalf of almost 100 countries. The tender is to help secure mpox vaccines for the “hardest hit countries” in a collaboration with Africa CDC, Gavi, WHO, PAHO, and other partners.
“This collaboration to increase access and timely allocation also includes working to facilitate donations of vaccines from existing stockpiles in high-income countries with the aim of containing the ongoing transmission of mpox.”
Emergency tender
Through the emergency tender UNICEF will establish conditional supply agreements with vaccine manufacturers to purchase and ship vaccines “without delay” once countries and partners have secured financing, confirmed demand and readiness, and regulatory requirements are in place. WHO is reviewing the information submitted by manufacturers in response to its invitation for expressions of interest for Emergency Use Listing.
The emergency tender is intended to secure immediate vaccine access and expand production. Agreements for up to 12 million doses through 2025 could be put in place, depending on demand, production capacity, and funding.
Ensuring equitable access
Director of UNICEF Supply Division, Leila Pakkala, highlighted the “paramount importance” of addressing the mpox vaccine shortage and delivering vaccines to “communities who need them now”.
“There is also a pressing need for a universal and transparent allocation mechanism to ensure equitable access to mpox vaccines.”
Dr Jean Kaseya, Director General of Africa CDC, agreed that “timely procurement and distribution” is “crucial to protecting the most vulnerable populations”. Dr Kaseya described the emergency tender as a “critical step forward in our collective effort to control the spread of this disease”.
“Africa CDC is committed to ensuring that vaccines are allocated swiftly and equitably across the continent, in partnership with UNICEF, Gavi, WHO, and other key stakeholders. Our unified response is essential to curbing the impact of this public health emergency and safeguarding the health and well-being of our communities.”
Dr Derrick Sim, Gavi’s interim Chief Vaccine Programmes and Markets Officer, echoed the significance of the emergency tender.
“Securing access to supply and financing, delivering doses, and in parallel ensuring countries are ready to administer them, are all vital actions that need to be conducted rapidly but thoroughly, and in a coordinated manner.”
Dr Sim welcomed the tender as “another positive step” in the response. WHO’s incidence manager for the global mpox response and acting Director for Epidemic and Pandemic Preparedness and Prevention is Dr Maria Van Kerkhove, who stated that a “swift, coordinated, and equitable response is critical” in the control of this mpox emergency and future iterations.
“All of us must act decisively now or risk allowing mpox to spread further and become an even greater global threat. In an interconnected world, the fight against mpox – as with other infectious diseases and health threats – cannot be waged alone.”
Dr Van Kerkhove shared that WHO is “glad to partner” on efforts to “get life-saving tools to people in need”.
For more on effective access strategies at the Congress in Barcelona this October, get your tickets to join us here, and don’t forget to subscribe to our weekly newsletters here.
by Charlotte Kilpatrick | Aug 30, 2024 | Global Health |
The Annenberg Public Policy Centre (APPC) shared a report in August 2024, revealing that the number of Americans believing COVID-19 vaccination misinformation has risen and their “willingness” to take or recommend vaccination against COVID-19 is “lower than in the past”. The Annenberg Science and Public Health (ASAPH) Knowledge Monitor tracks national levels of health knowledge and misinformation to generate “indices of knowledge” about health topics. The latest report is based on 20 waves of a nationally representative panel survey of US adults, the most recent of which was conducted in July 2024.
Confidence levels
The survey asks respondents to report their level of confidence in people who provide public health information. Respondents had the most confidence in primary care providers regarding “matters of public health” in 2023 and 2024. However, they had less confidence in public health institutions like the FDA and CDC. Respondents expressed least confidence in Dr Fauci, who stepped down as NIAID Director at the end of 2022.
In February 2024, Americans reported trusting scientists and police officers to act in their best interests “more than other groups”, including business leaders and journalists. Medical scientists were trusted “significantly more than any other group”. Confidence in the trustworthiness of the FDA exceeded specific measures of confidence concerning the FDA’s vaccine approval process. The four items assessing the FDA protecting the vaccine process from outside influence were the most highly correlated with each other and general confidence in the FDA.
COVID-19 misinformation and vaccines
The report emphasises that vaccines are “one of the great success stories of public health”. However, recent years have seen “declines in Americans’ perceptions that a variety of vaccines are safe and effective”. Although “most respondents” report vaccines as safe (65%-81%) and effective (61%-83%), respondents showed “significant declines” in perceptions of safety for MMR and COVID-19 vaccines, and in perceptions of efficacy for MMR, seasonal flu, and pneumonia vaccines.
Respondents considered MMR and seasonal flu vaccines safer and more effective (75%-83%) than the COVID-19 (65%-66%), even though CDC evidence indicates that the COVID-19 vaccines are “actually more effective” than flu vaccines. The authors also identify an increase in perceptions that the COVID-19 vaccines are “very or somewhat unsafe” (18%-24%).
The surveys tracked the amount of endorsement of five COVID-19 vaccine misinformation beliefs for nearly three years. Although most respondents still endorse the “science-consistent response” (55%-65%), endorsing the “science-inconsistent response” has increased over time. The “misinformed belief” that COVID-19 vaccinations have been responsible for thousands of deaths in the US increased from 22% in June 2021 to 28% in July 2024. Another trend was an increase in the “false belief” that it is safer to get a COVID-19 infection than a COVID-19 vaccine.
Vaccination in pregnancy
From June 2023 to April 2024, respondents increased their understanding of the vaccinations recommended during pregnancy by the CDC. In the most recent assessment, many respondents knew that seasonal flu (50%), COVID-19 (43%), and the Tdap (35%) vaccines are recommended in pregnancy. However, the recent survey also found that “large numbers of people” are “uncertain or do not know” the benefits of COVID-19 vaccination during pregnancy. Opinions were divided on whether to recommend the RSV vaccine to a pregnant friend or family member.
Measles
Despite the availability of an MMR vaccine that provides “long-lasting protection” against measles for people who have received both recommended doses, only 93% of kindergarten students in the US in 2022-2023 had received both doses. Exemption requests in the 2022-2023 school year, while still low, increased to 3.0% from 2.6% in the previous year.
“These increases in exemptions could be attributable to actual increases in vaccine hesitancy or persistent barriers to vaccination for families whose access to routine childhood vaccination series was reduced by the COVID-19 pandemic.”
The American public “remains relatively confident” in the vaccine for measles, mumps, and rubella. In October 2023, respondents perceived the MMR vaccine as “safer and more effective than any other surveyed vaccine”; 81% reported that the MMR is either “somewhat or very safe” and 83% reported it as “somewhat or very effective”. However, these perceptions represent a “significant decline” from August 2022, when 88% of respondents reported that the MMR vaccine was “somewhat or very safe” and 87% perceived it as “somewhat or very effective”.
In April 2024, a “large proportion of the public” knew that medical professionals recommend taking the MMR vaccine. However, less than half of respondents (49%) know that it is not more harmful than helpful to give children more than a single vaccine on the same day, and many were “not sure” (23%). Indeed, combining vaccines reduces the overall number of visits to the doctor, reducing barriers to “full, on-time vaccination”. Only 63% of respondents believe that healthy children should meet school vaccination requirements for attendance in public schools.
Most respondents (56%) were unsure about the effect of measles on potential pregnancy complications. About 4 in 10 people correctly identified two complications associated with contracting measles while pregnant: delivering a low-birth-weight baby and early delivery. Some people incorrectly indicated that diabetes (7%), blurred vision (11%), and death (12%) are more likely to occur if measles is contracted during pregnancy; this is not the case. Of particular concern is that a quarter of US adults still do not know that there is “no causal evidence” linking the measles vaccine to autism.
Mpox
As the “salience” of mpox receded in the US after the 2022 global outbreak, so has the public’s knowledge concerning the issue. The public is “significantly less worried about contracting mpox”; only 5% of respondents reported being “somewhat or very worried” about contracting mpox in the next 3 months. In July 2024, only 9% were worried about personally contracting mpox or someone in their family contracting mpox. 76% of respondents reported in October 2022 that they were “very likely or somewhat likely” to receive an mpox vaccine if they were exposed.
“In the immediate aftermath of the 2022 global mpox outbreak, many in the public learned important public health knowledge to help prevent and treat the disease. With new outbreaks recently declared in Kenya and the Central Africa Republic, now is the time for public health officials to remind the public of the risks, symptoms, and means of treatment.”
STIs
Sexually transmitted infections (STIs) are “on the rise” in the US. Thus, it is “not surprising” that 47% of respondents reported either having personally been diagnosed or knowing someone who had been diagnosed with an STI. However, just over half of respondents (54%) know that a case of syphilis can be permanently cured and most either believe (mistakenly) that there is a vaccine to prevent it (16%) or are unsure (45%). The public is “not sure” whether some STIs can be permanently cured or whether a vaccine exists to prevent them.
When asked about vaccines to prevent these infections, 67% of the public are aware that these a vaccine for HPV. 44% know that there is a vaccine for mpox. For infections without a vaccine, most of the public is either unsure or incorrect about whether that is the case:
- 61% of people do not know there is no vaccine for syphilis
- 52% of people do not know there is no vaccine for HIV
- 57% of people do not know there is no vaccine for gonorrhoea
- 55% of people do not know there is no vaccine for genital herpes
- 59% of people do not know there is no vaccine for chlamydia
To read the full report click here. Get your tickets to join us at the Congress in Barcelona for discussions about vaccine confidence, public health communication, and vaccine uptake, and don’t forget to subscribe to our weekly newsletters here.
by Charlotte Kilpatrick | Aug 29, 2024 | Global Health |
A study in The Lancet Public Health by researchers at Karolinska Institutet finds “disparities’ in cervical cancer prevention among girls with mental health conditions in Sweden. The authors call for research to ensure equitable protection after their population-based cohort study found that uptake of the first human papillomavirus (HPV) vaccine dose was “lower among girls with versus without any mental health condition”. HPV vaccination is critical to WHO’s global goal of eliminating cervical cancer as a public health problem, with an aim 90% of girls vaccinated against HPV by the age of 15.
Uptake concerns
Cervical cancer is the “fourth most common” cancer among women worldwide, and women with mental illness or neurodevelopmental conditions have a “higher risk of invasive cervical cancer and lower cervical screening participation rate”. They also face “worse cervical cancer-specific survival”. Opportunistic HPV vaccination for girls began in Sweden in 2006; a nationwide school-based programme was initiated in 2012, bringing free vaccination to all girls in school grades 5-6 (ages 10-13 years). Coverage reached 91% in 2023.
Mental illness or neurodevelopmental conditions have been linked to reduced uptake of “various” vaccines. Although there are “multifactorial” and varied reasons for this, potential barriers include:
- Lower engagement in preventive behaviours
- Psychological factors resulting in challenges with assess the benefits versus harms of vaccination
- Absence of specialist knowledge among vaccination providers
The study
The authors aimed to explore a potential link between mental illness and neurodevelopmental conditions in girls and their parents and uptake of HPV vaccination in the Swedish school-based HPV vaccination programme. They conducted a population-based cohort study, identifying all girls born between 1st January 2002 and 1st March 2004.
Psychiatric disorders (mental illness) and neurodevelopmental conditions were included in the definition of mental health conditions, which were defined using specialist diagnoses from inpatient and outpatient hospital visits reported in the Swedish National Patient Register (NPR). Mental health conditions were also categorised by severity and treatment status:
- No specialist diagnosis of mental health condition or prescribed use of psychotropic medication
- Medication use but no diagnosis
- Diagnosis but no medication use
- Diagnosis and medication use
Parental mental health conditions were also defined according to this framework. HPV vaccination was defined through the Swedish HPV Vaccination Register (SVEVAC), the National Vaccination Register (NVR), and the Prescribed Drug Register (PDR).
131,869 girls were identified with the Swedish Total Population Register. Those who emigrated from Sweden (4,610), died before the 15th birthday (498), immigrated to Sweden after the 10th birthday (11,626), or received an HPV vaccine before the 10th birthday (31) were excluded. Therefore, the study population was 115,104 girls. Information was available for 110,055 mothers and 107,862 fathers. 2,211 girls had a specialist diagnosis of any mental health condition and 21,185 were exposed to any parental mental health condition diagnosis.
Uptake of the first dose of the HPV vaccine was 80.7%. First dose vaccine uptake was lower among girls with a specialist diagnosis of any mental condition, compared to girls without. Similar findings were identified across mental health conditions, except for stress-related disorders.
“The diagnoses of autism or intellectual disability were most strongly associated with lower first dose HPV vaccine uptake.”
First dose uptake was also lower among girls with prescribed use of any psychotropic medication; this was most strongly observed for antipsychotics. First dose vaccine uptake was “similar” for girls with and without exposure to parental mental health condition diagnosis, but “small differences” were observed according to whether the diagnoses were present in only the mother, only the father, or in both parents.
Although the association of any mental health condition or prescribed psychotropic medication use with first dose uptake was “similar” across sociodemographic variables and parental mental health condition variables, the association varied across paediatric comorbidity index (PCI) scores.
“Post-hoc analyses showed that girls with a psychiatric and neurodevelopmental condition had lower vaccine uptake than those with none of these conditions, and those with intellectual disability and autism had the lowest uptake.”
92,912 girls who received the first vaccine dose were eligible for analysis of second dose uptake. Of these, 1,576 had a specialist diagnosis of any mental health condition. Uptake of the second HPV vaccine dose was 95.0%; 1,468 girls had a specialist diagnosis of any mental health condition and 86,840 did not. Second dose uptake was similar between girls with exposure to parental mental health condition diagnosis and those without.
Conclusions and comments
The study develops previous research to reveal that the “presence of neurodevelopmental conditions and psychiatric disorders or multiple neurodevelopmental conditions” is associated with “particularly low vaccine uptake”. However, it doesn’t show a strong association between mental health conditions and the uptake of a second HPV vaccine dose. The authors infer that the “main barriers” to HPV vaccination faced by those with mental health conditions are experienced at “vaccine initiation” and could “diminish” after receipt of the first dose.
“Research into the potential barriers for vaccination among individuals with mental health conditions, especially young people, is scarce. However, lower access to, or engagement with, preventive health care, including vaccination opportunities, due to more frequent absence from school among girls with mental health conditions is likely to play a part.”
The researchers conclude that future research should strive to facilitate “equitable protection”. Dr Kejia Hu from the Institute of Environmental Medicine emphasises the need for “targeted interventions” to achieve “equitable healthcare for all children”.
“All girls should have equal access to life-saving vaccines regardless of their mental health status.”
Dr Karin Sundström of the Centre for Cervical Cancer Elimination at the Department of Clinical Science, Intervention, and Technology, looks forward to future studies to address the inequalities.
“More research is needed to find out the underlying reasons why fewer girls with mental illness or neuropsychiatric conditions are vaccinated against HPV so that we can tackle this challenge.”
We will consider barriers to uptake of various vaccine programmes at the Congress in Barcelona this October so do get your tickets to join these discussions and don’t forget to subscribe to our weekly newsletters here.
