by Charlotte Kilpatrick | Aug 2, 2024 | Global Health |
A paper in Nature Human Behaviour (not open access) in August 2024 presents a meta-analysis examining different types of vaccination intervention strategies and their applications in different countries. The authors analysed the results from 88 eligible randomised controlled trials involving 1,628,768 participants in 17 countries. They estimated the efficacy of seven intervention strategies to find that incentives and increased access were “most promising” in improving vaccination uptake; the access strategy was particularly effective in countries with “lower incomes and less access to healthcare”.
The study
The systematic review and meta-analysis study develops previous research, which has previously focused on specific vaccines, specific intervention strategies, or specific populations. The team considered 7 types of vaccine intervention strategies:
- Increasing access to vaccination
- Sending vaccination reminders
- Providing incentives
- Supplying information
- Correcting misinformation
- Promoting active and passive motivation
- Teaching behavioural skills
Interventions were associated with around a 50% higher chance of vaccination than ‘control’ situations without an intervention. Two interventions were “most promising”; interventions that increased access to vaccines had a “moderate effect”, especially in countries with low access to vaccines and quality of healthcare. There was also a “small effect” from incentives, and “non-significant effects” from the other interventions.
The interventions to increase access to vaccines included offering transportation assistance or bringing vaccines to recipients at nursing homes, family homes, or workplaces. These methods tripled the odds of vaccination, with greater effects in lower-income countries. Financial incentive interventions included a US study that reached an 85% influenza vaccination rate when physicians were reimbursed $1.60 a dose. This is an increase on the 70% vaccination rate when they were reimbursed $0.80 per dose.
Evidence of successful interventions
Dr Dolores Albarracín, Amy Gutmann Penn Integrates Knowledge University Professor at the University of Pennsylvania and director of the Communication Science division at the Annenberg Public Policy Centre (APPC) states the importance of “figuring out which approaches help increase immunisation, and under what circumstances”. This could enable global public health leaders to “allocate resources more efficiently and ultimately improve health outcomes”.
“Public health officials often say that ensuring vaccine access is the first step to promoting immunisation. Our meta-analysis provides hard evidence in support of this recommendation and indicates that this should be a special priority in under-resourced areas with limited access to health care.”
On the other hand, Dr Albarracín reflects the research suggests that correcting misinformation does not ensure health behaviours like vaccination. This is despite its challenge to democracy and “highly salient” threat.
Join us at the Congress in Barcelona to share your insights on effective interventions and vaccination strategies to encourage uptake, and don’t forget to subscribe to our weekly newsletters here for vaccine updates.
by Charlotte Kilpatrick | Aug 2, 2024 | Global Health |
In August 2024 WHO and CEPI shared a joint release calling on researchers and governments to “strengthen and accelerate” global research in preparation for the next pandemic. The statement highlights the importance of extensive research across “entire families” of pathogens that can infect humans, regardless of perceived pandemic risk, as well as a focus on individual pathogens. A report issued at the Global Pandemic Preparedness Summit 2024 in Brazil encourages the development of broad capabilities for rapid adaptation to emerging threats.
Pathogen prioritisation: a framework
The WHO R&D Blueprint for Epidemics’ primary goal is the accelerated development of medical countermeasures (MCM) and making these countermeasures available for diseases with epidemic and pandemic potential. It serves as a “global platform for research and development collaboration”. Central to the efforts is the concept of “pathogen prioritisation”.
The latest report outlines the results of a global pathogen prioritisation process with over 200 scientists from more than 50 countries. They evaluated the evidence related to 28 viral families and one core group of bacteria; this encompassed 1,652 pathogens.
“This process emphasised the imperative nature of collaborative efforts to attain global resilience against epidemics and pandemics.”
The report states that the approach encourages a focus on research of viral and bacterial families, rather than “isolated pathogens”, and emphasises the “critical necessity for investments in research, development, and innovation on an international scale”.
The ‘streetlight effect’
The report introduces a metaphor known as the ‘streetlight effect’, which describes looking for lost keys under a streetlamp to illustrate natural biases in research; this implies that we tend to search “where it is easiest”, rather than where the “actual answers might lie”. In this context, the area that is lit by the streetlamp represents Priority Pathogens, which are well-studied with plenty of data. The light area can be expanded by researching the Prototype Pathogens, representative viruses within a viral family that can be used as “pathfinders” to generate evidence and fill knowledge gaps with applications across the family.
Outside the illuminated area are the “Dark Areas”, including “under-monitored and under-studied” regions. These areas could harbour novel pathogens, but a lack of infrastructure and resources hinders comprehensive research. Thus, the proposed approach of research across all families, regardless of pandemic potential, could mitigate the risk of overlooking potential pandemic pathogens.
CORC
WHO is engaging research institutions across the world to establish a Collaborative Open Research Consortium (CORC) for pathogen families. Each family will have a WHO Collaborating Centre acting as a research hub. These CORCs will engage researchers, developers, funders, regulators, trial experts, and other stakeholders to promote “greater research collaboration and equitable participation”, especially in places where the pathogens are known to or highly likely to circulate.
Not if, but when
Dr Richard Hatchett, CEO of CEPI, described the scientific framework for epidemic and pandemic research preparedness as a “vital shift in how the world approaches countermeasure development”. He emphasised that CEPI “strongly” supports this step.
“This framework will help steer and coordinate research into entire pathogen families, a strategy that aims to bolster the world’s ability to swiftly respond to unforeseen variants, emerging pathogens, zoonotic spillover, and unknown threats referred to as pathogen X.”
WHO Director-General, Dr Tedros Adhanom Ghebreyesus, demands a “combination of science and political resolve” in preparation for the next pandemic.
“History teaches us that the next pandemic is a matter of when, not if. It also teaches us the importance of science and political resolve in blunting its impact.”
The efforts to advance pathogen knowledge require participation of “scientists from every country”.
Pandemic preparedness and pathogen research remain central to discussions at the Congress in Barcelona, so do get your tickets to join us for these sessions in October, and don’t forget to subscribe to our weekly newsletters for global health insights.
by Charlotte Kilpatrick | Jul 31, 2024 | Global Health |
In July 2024 the Regionalised Vaccine Manufacturing Collaborative (RVMC) shared its strategy for 2024-2027, launched by Dr Frederik Kristensen, Inaugural Managing Director. Dr Kristensen states that the strategy comes at a time of “considerable interest and activity around regional vaccine manufacturing”.
“Spurred on by the deep inequities in vaccine access experienced during the COVID-19 pandemic, the past two years have seen a surge in public and private investments in regionalised vaccine manufacturing.”
The strategy suggests that regional consolidation will achieve the necessary scale of “demand, investment, and capability” to “maintain viable and sustainable vaccine production”.
RVMC
RVMC was launched by the World Economic Forum (WEF), the US National Academies of Medicine (NAM), and CEPI in 2022 with the goal of tackling the “glaring inequities within the global vaccine production ecosystem”. Its vision is a “world where vaccine equity and health security are created for countries in all regions”, which can be realised through the establishment of regional vaccine manufacturing and supply chain networks that can produce vaccines for routine use in a “sustainable manner”, with outbreak readiness.
The first phase of RVMC was focused on building a robust partner community, fostering regional collaboration, and developing the RVMC Framework. The Framework outlines eight pillars for a sustainable vaccine manufacturing ecosystem:
- Business archetypes
- Healthy markets
- Financial models
- R&D and manufacturing innovation
- Technology transfer and workforce development
- Supply chain and infrastructure
- Product regulation
- Policy and governance
In January 2024 the founding parties confirmed the continuation of RVMC for the coming three years, with support from key partners such as PAHO and Africa CDC. For this phase, RVMC is seeking to create value by:
- Advocating for regionalised manufacturing
- Aligning key initiatives
- Advising on approaches
- Accounting for progress
Advocating for change
RVMC will “make the case” for regionalised vaccine manufacturing, setting out a global vision for the “regionalisation agenda” and enabling others to “define and implement their regional approach”. It will build consensus around what regionalised vaccine manufacturing means and establish policy positions and access to data. Raising awareness and engagement with a global vision will “foster a common approach” between partners. This step will be facilitated by “thought leadership and evidence generation”.
Aligning partners for impact
Discussions will be held within and between regions and stakeholders, with RVMC working to align projects to “common objectives and regional priorities”. The strategy highlights the importance of “convening partners around a unified vision” to ensure that available resources are used efficiently, and in a “coordinated and coherent manner”.
“Better coordination should generate more impact and encourage further investment in the regionalisation agenda, therby improving the economic sustainability of vaccine manufacturing. Independent convening, matchmaking, and facilitating dialogue will be key enablers of this work.”
Advising on sustainable approaches
Independent trusted advice will be offered to stakeholders by RVMC, with a focus on expanding the “fact base” for current global and regional capacity, capabilities, and coverage. This element will “champion existing data providers” and identify data gaps. For example, it is currently “not clear” what manufacturing capacity is already in place, and what additional resources will be needed to make regionalised manufacturing a reality. Thus, publishing this position with perspectives on what is needed will support manufacturers who are trying to develop viable business models, funders hoping to support regional supply chains, and stakeholders working on the creation of healthy markets.
Accounting for progress
Following the Framework, RVMC will “observe and report on progress” across the eight pillars. This will enable all stakeholders to “see the whole picture” and the Secretariat to identify areas of need. It also feeds into the ongoing Advocacy role and could provide insights and encouragement for attracting sustainable investment.
The perfect opportunity
Dr Kristensen believes that RVMC is “uniquely suited” to providing stakeholders with the support they need; it is “fully dedicated to the vaccine regionalisation agenda” and is “intentionally positioned between regions and between global and regional bodies”.
“We’ve never had a better chance to advance vaccine equity and health security for all than now, and through our 2024-2027 strategy we’re committed to working with all partners to create regional vaccine manufacturing as a core element to deliver this.”
We’re looking forward to exploring regional vaccine manufacturing at the Congress in Barcelona this October in a panel on regional capacity and resilient systems. Get your tickets to join us here, and don’t forget to subscribe to our weekly newsletters here.
by Charlotte Kilpatrick | Jul 31, 2024 | Global Health |
A paper in Nature Communications in July 2024 explores the effect of COVID-19 vaccines on cardiovascular diseases by examining longitudinal health records from 45.7 million adults in England between December 2020 and January 2022. The authors find that the incidence of common arterial thrombotic events and the incidence of common venous thrombotic events were lower after vaccination. However, there was a higher incidence of previously reported “rare harms” after vaccination. Overall, the researchers offer their findings in support of “wide uptake of future COVID-19 vaccination programmes”.
The study
Although SARS-CoV-2 vaccination “prevented 14.4 million deaths from COVID-19″ across the world in the first year of the pandemic, the authors identify a need to understand the risk of thrombotic and cardiovascular complications. COVID-19 vaccines are associated with rare cardiovascular complications:
- mRNA-based brands are associated with myocarditis
- Adenovirus-based brands are associated with vaccine-induced thrombotic thrombocytopenia (VITT)
In their study, the authors use whole population longitudinal electronic health records for 45.7 million adults in England to quantify associations of first, second, and booster doses of mRNA and non-mRNA COVID-19 vaccine brands with subsequent thrombotic and cardiovascular events. Through Cox regression, they estimated adjusted hazard ratios (aHRs) and corresponding 95% confidence intervals in time intervals since vaccination, adjusted for various co-morbidities, age, sex, and prior COVID-19.
“We show that the incidence of thrombotic and cardiovascular complications was generally lower after each dose of each vaccine brand, except for previously recognised rare complications of the ChAdOx1 vaccine and the mRNA vaccines.”
Findings and implications
Although the incidence of thrombotic and cardiovascular complications was “generally lower” after each dose of each vaccine brand, the authors highlight exceptions. These are consistent with previous findings:
- ChAdOx1 vaccine (ICVT and thrombocytopenia)
- mRNA vaccines (myocarditis and pericarditis)
“These findings, in conjunction with the long-term higher risk of severe cardiovascular and other complications associated with COVID-19, offer compelling evidence supporting the net cardiovascular benefit of COVID vaccination.”
Some of the key findings include:
- The incidence of composite arterial thrombotic events (AMI, ischaemic stroke, and other arterial embolism) was similar or lower after first, second, and booster doses of ChAdOx1 and BNT-162b2 vaccines and booster doses of mRNA-1273, compared to follow-up before or without the corresponding dose.
- The incidence of composite venous thrombotic events (PE, DVT, ICVT, PVT) was generally lower after first, second, and booster doses vaccination, compared to follow-up before or without the corresponding vaccine dose.
- Myocarditis incidence was higher after first dose of BNT-162b2 vaccine, higher one week after second dose of BNT-162b2, and higher after some mRNA booster vaccinations.
- Pericarditis incidence was higher after the first dose of ChAdOx1, after first dose of BNT-162b2, after second dose of BNT-162b2, and after mRNA-based booster vaccination.
The paper offers “reassurance” on the cardiovascular safety of COVID-19 vaccines, finding lower incidence of common cardiovascular events that outweighs the higher incidence of their known rare cardiovascular complications. Additionally, no novel cardiovascular complications or associations with subsequent doses were identified.
“Our findings support the wide uptake of future COVID-19 vaccination programmes. We hope this evidence addresses public concerns, supporting continued trust and participation in vaccination programmes and adherence to public health guidelines.”
Commenting on their paper, the authors emphasise the importance of gathering evidence on the risks and benefits of the COVID-19 vaccination programme. Dr Samantha Ip, co-author from the University of Cambridge, says that the research adds to a “large body of evidence” on the programme, which has “been shown to provide protection against severe COVID-19 and saved millions of lives worldwide”. Professor William Whiteley from the University of Edinburgh reflects that “over 90% of the population over the age of 12” received “at least one dose by January 2022”.
“This England-wide study offers patients reassurance of the cardiovascular safety of first, second, and booster doses of COVID-19 vaccines. It demonstrates that the benefits of second and booster doses, with fewer common cardiovascular events include heart attacks and strokes after vaccination, outweigh the very rare cardiovascular complications.”
Dr Venexia Walker of the University of Bristol emphasises the need to “continue to study” COVID-19 vaccines.
“The availability of population-wide data has allowed us to study different combinations of COVID-19 vaccines and to consider rare cardiovascular complications. This would not have been possible without the very large data that we are privileged to access and our close cross-institution collaborations.”
To join us for important discussions on the safety of COVID-19 vaccines, why not get your tickets to the Congress in Barcelona this October? Don’t forget to subscribe to our weekly newsletters here.
by Charlotte Kilpatrick | Jul 30, 2024 | Global Health |
In July 2024 Airfinity announced a reduction in its sales projections for vaccines against Respiratory Syncytial Virus (RSV) for older adults in the US. This is set to decrease from $4.7 billion a year to $1.7 billion by 2030. In 2023 the market revenues in the US reached around $2.4 billion, but Airfinity’s framework indicates that 2024 revenues will decline slightly to $2.2 billion. Airfinity attributes this projection to CDC Advisory Committee on Immunisation Practices (ACIP) recommendations that vaccines should be offered as a single lifetime dose for older adults. The estimated demand and revenue projections were based on proxies from previous vaccination campaigns.
Changing demand
Airfinity suggests that ACIP was “hesitant” to share a decision on potential booster doses after the rollout of RSV vaccines last year, due to “concerns about the risk versus benefit of additional doses”. Before the new recommendations, people aged 60 and above in the US were offered the RSV vaccine. Under the updated guidance, the vaccines will be offered to people over 75 years and those at high risk over the age of 60. This reduces the estimated eligible population by 44% to 46 million.
Another influencing factor is that the recommendation for high risk 50 to 59-year-olds was delayed in anticipation of further safety and “other” data. This delay is suggested to amount to around $300 million lost revenue for GSK. These losses are exacerbated by GSK’s use of a Priority Review Voucher, which is “commonly valued” between ~$20 million and $100 million, to accelerate regulatory review of the label expansion.
Dropping the boosters
Previous estimates from Airfinity in 2023 indicated that the market would generate sales of $4.7 billion a year by 2030 in the US, working under the assumption that boosters would be offered annually. However, GSK efficacy data was released to show that revaccinated after 12 months did not increase efficacy over a single dose, alongside data on the potential risk of Guillain-Barré Syndrome (GBS) associated with additional doses. If recommendations change in the future to reflect long-term efficacy and safety data, a recommendation for a booster every two or three years could increase the US market value to $6.6 billion or $5.2 billion.
Airfinity’s RSV Lead, Isabella Huettner, commented that the recommendations will “likely stunt revenue growth in the US market” unless new data offer support for the benefit of booster shots. Although global rollout will offer “additional revenue opportunities” for GSK, Pfizer, and Moderna as other countries launch vaccination programmes, the “trend appears to be for a single lifetime vaccine recommendation” for over 75s.
“US market share estimates are difficult to anticipate at this point with different scenarios being possible.”
Huettner believes that GSK is the “most likely to capture the majority of the market in the long term” thanks to “promising efficacy and durability”. Furthermore, although safety concerns “remain until more data become available”, GSK seems to have lower GBS rates than Pfizer.
“It will be interesting to see how Moderna’s vaccine will perform; while durability is lower with only ~50% efficacy after 18 months, as of now no vaccine-attributable cases of Guillain-Barré Syndrome have been observed with the shot. Should additional data confirm improved safety signals for Moderna’s shot, the vaccine could be favoured by some healthcare providers over other options, despite lower durability.”
For more on RSV vaccination strategies to maximise protection and ensure safety, why not join us at the Congress in Barcelona this October? Don’t forget to subscribe to our weekly newsletters here.
by Charlotte Kilpatrick | Jul 29, 2024 | Global Health |
CEPI announced in July 2024 that a clinical trial to assess if an mpox vaccine can protect against mpox after contact with the infection has received US$4.9 million from CEPI and the Canadian Institutes of Health Research. The ‘SMART’ trial will launch in the Democratic Republic of Congo (DRC) as well as Nigeria and Uganda. It will test if post-exposure vaccination with Bavarian Nordic’s MVA-BN mpox vaccine can reduce the risk of secondary mpox cases and explore whether it can reduce the severity of illness after infection.
A “large and deadly outbreak”
CEPI states that this trial could be “crucial” in shaping mpox vaccination strategies to address a “large and deadly outbreak” that has been escalating in the DRC and neighbouring countries. In 2024 over 11,000 cases and 443 deaths have been reported from DRC, with children accounting for most infections and deaths. The mpox strain causing the current outbreak is Clade I, estimated to be fatal in between 8% and 12% of cases and spread through direct contact. However, concern is also increasing at the emergence of Clade Ib in eastern regions, such as Kamituga and South Kivu. This appears to be spread through sexual transmission and skin-to-skin contact.
The study
The ‘SMART’ (Smallpox vaccine for Mpox post-exposure prophylaxis: A cluster Randomised controlled Trial) study will be led by Professor of Pathology and Molecular Medicine at McMaster University, Canada, Mark Loeb. It will involve over 1,500 participants aged 10 and over from households with laboratory-confirmed mpox infection. It will take place at sites in the DRC, Uganda, and Nigeria, and is set to launch in August.
Participants will be randomly allocated to receive a dose of MVA-BN or a control vaccine. Four weeks after allocation, scientists will compare the number of participants who contract mpox in each group and assess the severity of symptoms. This trial is the first randomised trial to assess the potential to vaccinate high-risk individuals post mpox exposure with this vaccine. Previous research identified a “substantially lower” risk of death for people vaccinated after exposure to the Ebola virus in DRC.
Professor Loeb describes the research as of “paramount importance”.
“It needs to be address with the utmost urgency.”
Dr Richard Hatchett, CEPI’s CEO, looks forward to “important real-world data in local populations, including older children”, which could be “key to informing mpox vaccine use recommendations” and help “bring an end to this devastating outbreak”.
“While healthcare workers typically vaccinate somebody before they are at risk of an infection, post-exposure-vaccinations allow for a more targeted approach, minimising use of vaccine supply. Here, individuals in high-risk groups – such as household contacts of an index case – are vaccinated to potentially reduce the risk of infection, improve survival odds, and stop onward chains of transmission.”
SMART design
Dr Patrick de Marie Katoto, Deputy Director of the Centre for Tropical Diseases and Global Health and Associated Professor of Clinical Epidemiology and Global Health Infection at the Catholic University of Bukavu in DRC stated that “SMART is so smart”.
“This project is not just intelligent because of its acronym but also because of its strategic and impactful approach to guiding public health interventions during crises. Assessing both the safety and efficacy of mpox vaccine in post-exposure scenarios will not only fill the current knowledge gap but also guide response strategies to save lives by protecting at-risk populations and preventing the spread.”
Dr Marisa Creatore, Executive Director of the Canadian Institutes of Health Research (CIHR) Centre for Research on Pandemic Preparedness and Health Emergencies is pleased to collaborate with CEPI in support of the “important” trial, which brings researchers together “for a common goal”.
“Viruses of zoonotic origins – mpox being one of many – are an increasing global health concern and we are happy to be able to contribute to the development of new public health tools to address these concerns.”
Bavarian Nordic’s President and Chief Executive Officer, Paul Chaplin, is “very proud” that the mpox vaccine will be used in the trial.
“Our company is firmly committed to working with the local authorities to develop solutions for vulnerable populations to combat the ongoing mpox outbreak in the DR Congo and other countries.”
For more insights into important vaccine trials and efforts to address infectious disease threats, why not join us at the Congress in Barcelona this October, or subscribe to our weekly newsletters here?
by Charlotte Kilpatrick | Jul 29, 2024 | Global Health |
A study in Nature Medicine (not open access) in July 2024 explores “emerging evidence” that Shingrix offers protection against dementia. The researchers used a natural experiment opportunity that was created by the “rapid transition” from use of live vaccines to recombinant vaccines to compare the associated risk of dementia. Not only was the recombinant vaccine associated with a “significantly lower risk of dementia” in the six years post-vaccination, but it was also associated with lower risks of dementia when compared with two other vaccines commonly used in older people: influenza and tetanus/diphtheria/pertussis vaccines.
Shingles vaccination
Shingles, or herpes zoster, is described as a “painful and serious” condition. It is a rash that can “occasionally result in permanent damage to the nerves or visual impairment” and affects many elderly people. A vaccination against shingles (Zostavax) was introduced in 2006, and since then several studies have indicated a link to a lower risk of dementia in people who had received this vaccine. However, in “many countries” it has now been withdrawn and replaced by a “much more effective” vaccine (Shingrix).
The study
The University of Oxford reports that the study involved more than 200,000 people. Researchers used the USA TriNetX electronic health records network to compare the risk of dementia in the six years after Shingrix compared to similar people who had received Zostavax before the switchover in October 2017. More than 100,000 people were in each group. Shingrix was also compared with vaccines against other infections.
The study found “at least” a 17% reduction in dementia diagnoses in the six years after the recombinant shingles vaccination. This equates to 164 or more additional days lived without dementia. Although this benefit was observed in both sexes, it was greater in women.
Further analyses suggest that the findings are “robust”, but the researchers emphasise the need for further investigation. Dr Maxime Taquet, NIHR Academic Clinical Lecturer in the Department of Psychiatry at Oxford led the study and hopes that the size and nature make the findings “convincing” and “motivate further research”.
“They support the hypothesis that vaccination against shingles might prevent dementia. If validated in clinical trials, these findings could have significant implications for older adults, health services, and public health.”
John Todd, Professor of Precision Medicine at Oxford’s Nuffield Department of Medicine, raised a “key question”: how does the vaccine produce this apparent benefit?
“One possibility is that infection with the Herpes zoster virus might increase the risk of dementia, and therefore by inhibiting the virus the vaccine could reduce this risk. Alternatively, the vaccine also contains chemicals which might have separate beneficial effects on brain health.”
Professor of Psychiatry and OH BRC Theme lead for Molecular Targets Paul Harrison supervised the study and described the findings as “intriguing and encouraging”.
“Anything that might reduce the risk of dementia is to be welcomed, given the large and increasing number of people affected by it.”
A need for more research
While experts have responded favourably to the study’s findings, they urge future research to better understand the mechanisms and implications of this apparent benefit. Professor Andrew Doig of the University of Manchester believes a clinical trial should now compare the recombinant vaccine to those who get a placebo. Another consideration is how long the effect lasts, and if people should be vaccinated at younger ages. Furthermore, Professor Doig recognised that linking herpes zoster virus to Alzheimer’s Disease is “looking more and more likely” but highlighted that “any such link is not simple”.
“A vaccine is therefore unlikely to ever totally prevent Alzheimer’s Disease. Many other factors affect the likelihood of getting dementia, such as genetics, cardiovascular problems, and head injuries. Nevertheless, tackling the herpes zoster virus does look to be a promising strategy towards defeating this horrible and costly disease, and one that should be vigorously pursued.”
Dr Sheona Scales, Director of Research at Alzheimer’s Research UK, also offered an opinion.
“Finding new ways to reduce people’s risk of developing these diseases is vital.”
Although the research is promising, it “isn’t clear how the vaccine might be reducing risk, nor whether the vaccine causes a reduction in dementia risk directly”.
“It will be critical to study this apparent effect further.”
For more on the latest vaccine research and innovation, why not join us at the Congress in Barcelona this October, or subscribe to our weekly newsletters here?
by Charlotte Kilpatrick | Jul 29, 2024 | Global Health |
On 28th July 2024 WHO marked World Hepatitis Day with the theme “it’s time for action”, calling for increased awareness of viral hepatitis. It stated that prevention, diagnosis, and treatment must be accelerated to address the tragedy of a death every 30 seconds from a hepatitis-related illness. Despite diagnosis and treatment innovation, alongside decreased product prices, WHO notes that “testing and treatment coverage rates have stalled”. However, it is hopeful that the 2030 elimination goal “should still be achievable, if swift action is taken now”.
Threat to the liver
Hepatitis is a liver inflammation that is “usually caused” by a viral infection or non-infectious agents like drugs, toxins, and alcohol. There are five main strains of the hepatitis virus (A, B, C, D, and E). They all cause liver disease, but types B and C combined are the “most common” cause of liver cirrhosis, loss of liver function, liver cancer, and viral hepatitis-related deaths. In 2022 they caused 1.3 million deaths, with around one hepatitis death every 30 seconds.
Around 220 million people with hepatitis B are undiagnosed, and nearly 36 million people with hepatitis C undiagnosed. As most symptoms emerge after the disease has advanced, many people only discover that they have hepatitis B or C when they develop serious liver disease or cancer. However, even after a diagnosis, coverage of treatment and care for people with hepatitis is “astonishingly low”.
WHO’s key messages
Under the World Hepatitis Day campaign WHO shared 4 “key messages”:
- A liver performs over 500 vital functions every single day to keep us alive. That’s why testing, treating, and preventing viral hepatitis is so important.
- Deaths from viral hepatitis-related causes are increasing.
- Globally, there’s a huge number of undiagnosed and untreated people living with hepatitis.
- So many hepatitis infections – and deaths – can be prevented.
- Reaching 2030 targets
WHO urges action to achieve the “ambitious targets” for 2030, suggesting that simplified care services for viral hepatitis should ensure that:
- All pregnant women living with chronic hepatitis B have access to treatment and their infants have access to hepatitis B birth vaccines to prevent infection
- 90% of people living with hepatitis B and/or hepatitis C are diagnosed
- 80% of diagnosed people are cured of hepatitis C or treated according to newer hepatitis expanded eligibility criteria.
Although there are tools and guidance to diagnose, treat, and prevent chronic viral hepatitis, these services are “still too often out of reach”. For example, rapid diagnostic tests for viral hepatitis cost less than US$2, but many people still face “out of pocket costs” for testing. Furthermore, despite the availability of affordable generic viral hepatitis medicines, too many countries overpay; medicines that are used to treated hepatitis C cost US$60 for a 12-week course, but countries can pay up to US$10,000.
Time to take action
WHO calls for action to prioritise testing, treatment, and vaccination to realise a hepatitis-free world and meet 2030 targets. Key actions include:
- Expanding access to testing and diagnostics to ensure more people can access the treatment they need
- Strengthening primary care prevention efforts to prevent hepatitis through vaccination, safe infection and injections practices, and education
- Decentralising hepatitis care to bring care closer to patients by utilising community-based services
- Integrating hepatitis care within existing healthy services, combining hepatitis treatment with primary care, HIV services, and harm reduction programmes where relevant to offer more accessible and comprehensive care
- Engaging affected communities and civil society, ensuring that the insights and experiences of people affected viral hepatitis are at the heart of prevention and treatment efforts
- Mobilising domestic or innovative financing to secure new funding avenues to support and sustain hepatitis elimination programmes.
ECDC marks World Hepatitis Day
The European Centre for Disease Prevention and Control (ECDC) also shared a statement addressing World Hepatitis Day 2024, focusing on the prevention of liver cancer. It states that chronic hepatitis is “among the main risk factors” for liver cancer, which is the sixth leading cause of cancer-related deaths in Europe; it accounted for nearly 55,000 deaths in 2022. Around 3.6 million people in the EU/EEA are chronically infected with hepatitis B virus (HBV) and hepatitis C virus (HBC), but infection prevalence and access to prevention and care “varies considerably”. A particularly high burden is identified in “vulnerable groups”, including people who infect drugs, people in prison, and some migrant populations.
ECDC calls for “enhanced efforts and collaboration between governments, healthcare providers, and communities, to accelerate progress”. It suggests that scaling up vaccination programmes, implementing targeted testing initiatives, ensuring systematic linkage to care, and enhancing infection prevention measures, we can “achieve a healthier future for all”. Dr Piotr Kramarz, ECDC Chief Scientist, demands intensified efforts.
“The power to prevent cancer is within our reach.”
For more on the management of infectious diseases and how vaccination strategies are critical to this endeavour, why not join us at the Congress in Barcelona this October, or subscribe to our weekly newsletters here?
by Charlotte Kilpatrick | Jul 19, 2024 | Global Health |
Researchers in Vaccine share their design of a training programme intended to enhance the skills and confidence of healthcare workers in “recognising and effectively responding” to misinformation. Through evidence-based misinformation strategies, learner engagement strategies, and authentic scenarios, the curriculum was developed for administration in 2023 in 8 countries. The authors place a “key emphasis” on a learner-driven approach that enables real-world application, and hope that their work can be used as a resource for practitioners.
Vaccine misinformation
The researchers recall WHO Director-General Dr Tedros Adhanom Ghebreyesus’ warning of a dangerous “infodemic” in parallel with the COVID-19 pandemic.
“An ‘infodemic’ describes the proliferation of information spanning a spectrum from credible to misleading to intentionally deceptive, inundating our everyday communication and making it difficult to discern accurate, reliable knowledge.”
This spectrum includes misinformation, which is false information shared “without intention of causing harm”, and disinformation, which is false information shared with an “intent to deceive” or serve an “agenda or political goal”. The implications of misinformation on public health, particularly attitudes to vaccination, are not new.
The role of healthcare workers
“Healthcare workers play an incredibly important role in combatting and responding to misinformation for vaccine communication; they routinely emerge as a trusted messenger for vaccine information for community members including in communities with lower levels of trust toward the government broadly, and the health care system specifically.”
They are often the primary point of contact for guidance and advice, but this responsibility is often unsupported with a “lack” of formal training on best practices. Furthermore, there are concerns that healthcare workers are also “being swayed by health misinformation” and feel insufficiently prepared to address it.
“There is a felt need amongst healthcare workers for support and trainings to be able to confidently respond to questions and growing concerns about vaccines, including responding to vaccine misinformation.”
Equipping healthcare workers
To support healthcare workers, the researchers developed training to provide evidence-based strategies to identify and reject misinformation. It uses participatory, problem-based learning. The goal was to provide healthcare workers with “concise, evidence-based practices” to respond to patients and support community members in addressing misinformation through “prebunking, debunking, and interpersonal communication strategies”.
Once the programme was developed, training took place in 2023 with 287 participants in eight countries: Cameroon, Guyana, Kenya, India, Mozambique, Nigeria, Philippines, and the US. It was translated from English into three other languages: French, Spanish, and Portuguese.
The curriculum
The training used findings from a pilot study and incorporated systematic reviews of social media, misinformation, and vaccine acceptance. A “robust” theory for mitigating misinformation is phycological inoculation theory, which finds that pre-exposing individuals to “weakened” versions of an argument can build “resistance” towards real-world examples of the argument. Thus, in the training, the authors presented learners with “weakened” formats of common misinformation, accompanied by refutations, to “build their cognitive resistance and enhance their ability to effectively identify and counteract false health information”.
Another strategy that they used is “prebunking”, or pre-emptive debunking. This “promising, scalable intervention” trains individuals to recognise common manipulative strategies used to spread misinformation. This puts the focus on a “generalisable skillset” for identifying misinformation across topics, providing a “general ‘immunity’ effect”. The researchers also used a debunking strategy, the process of correctly noting and refuting false information. The training allowed healthcare workers to refute false claims in simulated conversations.
The training reflected feedback from the initial pilot, which identified the importance of using intervention strategies that build trust and empathy in patient-provider interactions. Therefore, it included modules on best practices for evidence-based communication approaches.
Lessons and recommendations
The authors state that the principles of problem-based learning were “well-received” but that trainings could be more effective with contextualisation. However, they note an “inherent tension” between the benefits associated with tailored content and the “additional resources” required for customisation. Thus, a “middle ground” could use a “core” curriculum in a modular format with the possibility to tailor examples for specific cohorts.
“The results of our training add to the body of evidence that participatory, problem-based learning is effective and important.”
The paper is concluded with the hope that it can be used as a resource for practitioners and researchers who seek to implement similar, contextualised training.
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by Charlotte Kilpatrick | Jul 19, 2024 | Global Health |
Gavi announced in July 2024 that it has allocated nearly 200 million additional vaccine doses to contribute to the vaccination of around 50% of children in Gavi countries missed during the pandemic. This was achieved in collaboration with UNICEF and WHO and follows the approval of US$ 290 million by the Board last year in support of the “Big Catch-Up” initiative. With the doses allocated, all country requests that were received during the application window can progress to the implementation stage. Almost 32 million doses have already been shipped to 13 countries; a further 10 million are set to follow by the end of the month.
The Big Catch-Up
The Big Catch-Up initiative was launched by partners in April 2023 to address the decline in childhood vaccination rates that was observed during the COVID-19 pandemic. Recent immunisation coverage data for 2023 revealed variations across Gavi implementing countries; although there were improvements in 22 countries, these were “offset by sizeable declines” in other countries. Immunisation coverage in Gavi-supported countries “remained stable”, despite a growing birth cohort. However, the data also suggest an increase in the number of ‘zero-dose children’ in Gavi implementing countries.
Gavi’s “extraordinary” catch-up effort seeks to close immunisation gaps, restore immunisation coverage to pre-pandemic levels, and strengthen immunisation systems. Big Catch-Up funding is already allowing countries to identify and immunise unimmunised children, especially in hard-to-reach areas. Gavi offers the example of the Syrian Arab Republic, which rolled out a campaign to reach around 360,000 children from April 2024. Another example is Somalia, which is using the support to address some of the country’s widest gaps, administering measles vaccine, inactivated poliovirus vaccine (IPV), and diphtheria, tetanus, and pertussis-containing vaccine.
The list of antigens for Big Catch-Up activities is:
- Pentavalent
- HPV
- IPV
- Measles
- MR
- MMR
- MenA
- PCV
- ROTA
- Yellow Fever
Building resilience
Thabani Maphosa, Managing Director of Country Programmes Delivery at Gavi, commented that “lower-income countries made unprecedented efforts to vaccinate their populations” during the pandemic. However, this emergency response “strained their health systems”.
“Now, our priority is twofold: help countries regain lost ground in routine immunisation coverage and build more resilient and equitable vaccination programmes for the future.”
Gavi is “acting swiftly” with partners to support this “critical public health mission”. Maphosa states that “strong immunisation systems are the foundation for combating disease outbreaks and saving lives”.
For more on the vaccine community’s role in regaining lost ground, why not join us at the Congress in Barcelona this October? Don’t forget to subscribe to our weekly newsletters here.
by Charlotte Kilpatrick | Jul 18, 2024 | Global Health |
The first report from the UK COVID-19 Inquiry was released in July 2024, concluding that the UK was “ill prepared” to deal with the pandemic, despite assumptions that it was “one of the best-prepared countries in the world”. The Inquiry was established to “examine the UK’s response to and impact of the COVID-19 pandemic” in the hope that lessons can be identified for the future. This first report examines the state of the UK’s “central structures and procedures” for pandemic emergency preparedness, resilience, and response.
Introduction to the report
The Rt Hon Baroness Hallet DBE, Chair of the Inquiry, wrote the introduction to the report. This begins by highlighting that the “primary duty of the state is to protect its citizens from harm”. Therefore, the state must ensure that it is “properly prepared to meet threats” such as that of the emergence of a “novel and potentially lethal virus” in December 2019. SARS-CoV-2 and COVID-19 disease spread quickly across the globe, infecting and killing millions.
“The COVID-19 pandemic caused grief, untold misery, and economic turmoil. Its impact will be felt for decades to come.”
However, Baroness Hallet notes that “the impact of the disease did not fall equally”. Mortality rates were “significantly higher” among people with a physical or learning disability and people with pre-existing conditions. People from some ethnic minority groups and people living in deprived areas also had a “significantly higher risk” of COVID-19 infection and death.
“Beyond the individual tragedy of each and every death, the pandemic placed extraordinary levels of strain on the UK’s health, care, financial, and educational systems, as well as on jobs and businesses.”
In March 2020 the need for “serious and far-reaching decisions” led to a legally enforced ‘stay at home’ order, which Baroness Hallet describes as “hitherto unimaginable”. This “severely curtailed” the life of the UK with myriad implications.
“Societal damage has been widespread, with existing inequalities exacerbated and access to opportunity significantly weakened.”
Baroness Hallet commends the “individual efforts and dedication” of health and social care workers and civil and public servants who “battled the pandemic”, scientists, medics, and commercial companies who “valiantly” developed life-saving treatments and vaccines, local authority workers and volunteers who supported elderly and vulnerable people and vaccinated the population, and the emergency services, transport workers, teachers, food and medicinal industry workers, and other “key workers” who “kept the country going”. Their services will likely be “called upon again”, with “overwhelming” evidence suggesting that another pandemic is on the horizon.
“Unless the lessons are learned, and fundamental change is implemented, that effort and cost will have been in vain when it comes to the next pandemic. There must be radical reform. Never again can a disease be allowed to lead to so many deaths and so much suffering.”
In this context, the Inquiry was established. Consultations followed across the four nations to understand how the “gravest and most multi-layered peacetime emergency” hit the UK and how the government and devolved administrations responded. The Inquiry is conducted in modules; the first of these is Module 1 (Resilience and preparedness). Although other countries have initiated investigations into “many aspects” of the pandemic, Baroness Hallet suggests that this Inquiry has the “force of the law” behind it. She hopes that, if the recommendations are implemented, future loss and suffering can be reduced and policymakers will be “assisted in responding to a crisis”.
Flaws in the system
The Report states clearly that the UK “lacked resilience” in 2020 and entered the pandemic with a “slowdown in health improvement” and widened health inequalities. It was “more vulnerable” thanks to high levels of pre-existing disease and “general levels of ill-health and health inequalities”.
Although the Inquiry “recognises” that decisions about the allocation of resources to prepare for a “whole-system civil emergency” fall to elected politicians who might be tempted to address the “immediate problem”, the Report emphasises that “money spent on systems for our protection is vital” and will be “vastly outweighed” by the cost of “not doing so”. If the UK had been better prepared and more resilient, some of the financial and human cost might have been avoided.
The system of building preparedness for the pandemic “suffered” from some key flaws:
- The UK prepared for the wrong pandemic. Although the risk of an influenza pandemic had long been considered, written about, and planned for, the preparedness was inadequate for the global pandemic that struck.
- The institutions and structures responsible for emergency planning were labyrinthine in their complexity.
- There were fatal strategic flaws underpinning the assessment of the risks that the UK faced, how those risks and their consequences could be managed, and how they could be responded to.
- The UK government’s sole pandemic strategy dated back to 2011 and lacked adaptability. It was virtually abandoned in the face of the pandemic. It focused only on one type of pandemic, failed to adequately consider prevention or proportionality of response, and paid insufficient attention to the economic and social consequences of pandemic response.
- Emergency planning generally failed to account sufficiently for pre-existing health and societal inequalities and deprivation in society. There was also a failure to appreciate the full extent of the impact of government measures and long-term risks, from both pandemic and response, on ethnic minority communities and those with poor health or other vulnerabilities, and to engage appropriately with those who know their communities best.
- There was a failure to learn sufficiently from past civil emergency exercises and disease outbreaks.
- There was a damaging absence of focus on the measures, interventions, and infrastructure required in the event of a pandemic, including a system that could be scaled up to test, trace, and isolate in the event of a pandemic. Despite extensive documentation, planning guidance was insufficiently robust and flexible and policy documentation was outdated, overly bureaucratic, and infected by jargon.
- In the years before the pandemic there as a lack of adequate leadership, coordination, and oversight. Ministers, who are frequently untrained in the specialist field of civil contingencies, were not presented with a suitably broad range of scientific opinion and policy options, and failed to challenge sufficiently the advice they were given.
- The provision of advice could be improved. Advisors and advisory groups did not have sufficient freedom and autonomy to express dissenting views and suffered from a lack of significant external oversight and challenge. The advice was often undermined by ‘groupthink’.
“The Inquiry has no hesitation in concluding that the processes, planning, and policy of the civil contingency structures within the UK government and devolved administrations and civil services failed their citizens.”
Recommendations
The Report recommends “fundamental reform” of the approach to whole-system civil emergencies and emphasises that the recommendations must be implemented “in concert” to produce necessary change. The recommendations are:
- Each government should create a single Cabinet-level or equivalent ministerial committee (including the senior minister responsible for health and social care) responsible for whole-system civil emergency preparedness and resilience, to be chaired by the leader or deputy leader of the relevant government. There should also be a single cross-departmental group of senior officials in each government who oversee and implement policy on civil emergency preparedness and resilience.
- The lead government department model for whole-system civil emergency preparedness and resilience is not appropriate and should be abolished.
- The UK government and devolved administrations should develop a new approach to risk assessment that moves away from reliance on reasonable worst-case scenarios towards an approach that assesses a wider range of scenarios representative of the different risks and the range of each kind of risk. It should also better reflect the circumstances and characteristics of England, Scotland, Wales, and Northern Ireland as well as the UK as a whole.
- A new UK-wide whole-system civil emergency strategy should be established and subject to a substantive reassessment at least every three years to keep it up to date and effective, incorporating lessons from civil emergency exercises.
- The UK government and devolved administrations should establish new mechanisms for the timely collection, analysis, secure sharing, and use of reliable data to inform emergency responses, such as data systems to be tested in pandemic exercises. A wider range of ‘hibernated’ and other studies should also be commissioned to be rapidly adapted to a new outbreak.
- The UK government and devolved administrations should hold a UK-wide pandemic response exercise at least every three years.
- Each government should publish a report within three months of the completion of each civil emergency exercise summarising the findings, lessons, and recommendations, and publish within six months of the exercise an action plan that outlines specific steps to be taken in response.
- All exercise reports, action plans, emergency plans, and guidance from across the UK should be kept in a single UK-wide online archive, accessible to all involved in emergency preparedness, resilience, and response.
- Each government should produce and publish a report to their respective legislatures on whole-system civil emergency preparedness and resilience at least every three years.
- External ‘red teams’ should be regularly used in the Civil Service to scrutinise and challenge the principles, evidence, policies, and advice relating to preparedness for and resilience to whole-system civil emergencies.
- The UK government, in consultation with the devolved administrations, should create a UK-wide independent statutory body for whole-system civil emergency preparedness, resilience, and response. This body should provide independent, strategic advice, consult with voluntary, community, and social enterprise sector at a national and local level as well as directors of public health, and make recommendations.
Initial reactions
Professor Adam Kucharski of the London School of Hygiene and Tropical Medicine told BBC News that the findings would require action.
“We’re going to face more pandemic threats in future.”
Professor Kucharski urges answers to “what do we want a good response to look like” and “what do we need to be putting in place now to ensure that response is feasible”. Dr Saleyha Ahsan, who worked in hospitals during the pandemic and is now part of the COVID-19 Bereaved Families for Justice UK group, commented that it felt like there had been “zero planning” and the rules changed “on a daily basis”.
“It was ridiculous…It felt like we were making do and the people who were being pushed to the front were healthcare workers.”
For Dr Ahsan, it is “so important” to understand “where things went wrong and who was responsible”.
To read the full report, click here. Pandemic preparedness and response are key concerns at the Congress in Barcelona this October, so get your tickets to participate in these discussions, and don’t forget to subscribe for more updates.
by Charlotte Kilpatrick | Jul 17, 2024 | Global Health |
In July 2024 the Court of Justice of the European Union found that the EU Commission “did not give the public sufficiently wide access” to purchase agreements for COVID-19 vaccines. This is a response to an action for annulment, which challenges acts made by EU institutions that are “contrary to European Union law”. The Commission responded, saying it “takes note” of the judgements and will “carefully study” the conclusions and “their implications”.
Actions for annulment
The judgement considers purchase agreements for vaccines from 2020 and 2021, in which “approximately €2.7 billion were quickly released” to allow an order of over 1 billion doses. When some Members of the European Parliament (MEPs) and private individuals requested access to these agreements to “understand their terms and conditions and satisfy themselves that the public interest was protected”, the Commission granted only partial access. The documents were shared in redacted versions, which prompted the parties concerned to bring actions of annulment before the General Court.
Irregularities in Commission decisions
The General Court “upholds the two actions in part and annuls the Commission’s decisions in so far as they contain irregularities”.
- Concerning the agreements’ provisions on the indemnification of the pharmaceutical undertakings by Member States for any damages that those undertakings would have to pay in the event of their vaccines being defective, the General Court states that “a producer is liable for the damage caused by a defect in its product and its liability cannot be limited or excluded vis-à-vis the victim by a clause limiting, or providing an exemption from, liability under Directive 85/374 2”. However, it notes that the Directive does not prohibit a third party from reimbursing the damages which a producer has paid due to its product being defective. The reason for incorporating provisions on indemnification into the agreements has been endorsed by Member States and “fell within the public domain”.
“The General Court finds that the Commission did not demonstrate that wider access to those clauses would actually undermine the commercial interests of those undertakings. Similarly, the Commission did not provide sufficient explanations as to how access to the definitions of ‘wilful misconduct’ or ‘best reasonable efforts’, in some of the agreements, and as to how access to the agreements’ provisions on donations and resales of the vaccines, could actually and specifically undermine those commercial interests.”
- Concerning the protection of the privacy of individuals, the General Court states that “the persons who brought the action had duly demonstrated the specific purpose of the public interest in the disclosure of the personal data of the members of that team”.
“It was only by having the names, surnames, and details of the professional or institutional role of the members of the team in question that they could have ascertained whether or not the members of that team had a conflict of interests. Furthermore, the Commission did not take sufficient account of all the relevant circumstances in order to weigh up correctly the interests at issue, related to the absence of a conflict of interests and a risk that the right of privacy of the persons concerned might be infringed.”
The Commission responds
The Commission notes that the General Court has “only partially upheld the legal action on two points”. It emphasises that, following “principles of openness and transparency”, the Commission grants the “widest possible public access” to relevant documents. However, it “needed to strike a difficult balance” between the right of the public to information and the “legal requirements emanating from the COVID-19 contracts themselves”.
The Commission concludes that it “reserves its legal options”.
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by Charlotte Kilpatrick | Jul 17, 2024 | Global Health |
The UK Department of Health and Social Care announced in July 2024 that the UK will become the first country in the world to offer a national vaccination programme with the same vaccine for the protection of infants and older adults from Respiratory Syncytial Virus (RSV). Based on advice from the Joint Committee on Vaccination, the Pfizer vaccine will be offered from August in Scotland and September in England, Wales, and Northern Ireland. The rollout includes a vaccine for pregnant women over 28 weeks, a routine programme for people over 75, and a one-off campaign for those aged 75 to 79.
A “relatively unknown” threat
Although RSV is “relatively unknown” to the public, it infects around 90% of children in the first two years of life. It typically causes mild, cold-like symptoms but can also lead to severe lung infections like pneumonia and infant bronchiolitis. It is a “leading cause” of infant mortality globally. Every year in the UK, RSV accounts for approximately 30,000 hospitalisations in children under 5 and between 20 and 30 infant deaths. It also causes around 9,000 hospital admissions in people over the age of 75.
RSV puts pressure on health services, so it is hoped that this programme could “free up thousands of hospital bed days” and prevent “hundreds of deaths” each year. This will be particularly important during “challenging winter months”. Minister for Public Health and Prevention, Andrew Gwynne, expects that the vaccine will “save lives and protect the most vulnerable” but also “ease pressure on our broken NHS”. Gwynne reflected on his own experience with the “devastating effects” of the disease.
“My own grandson contracted RSV when he was just days old, leading to weeks in intensive care, and a lifelong impact on his health. I don’t want anyone to go through what he went through.”
A “huge step forward”
Steve Russell, NHS national director for vaccinations and screening, emphasised that RSV is a “very serious illness”.
“This rollout is a huge step forward and will undoubtedly save the lives of many of those most at risk.”
Russell “strongly” encourages people aged 75 to 79 to come forward for vaccination when they are invited, and for women who are 28 or more weeks pregnant to contact their maternity service or GP surgery to “ensure their baby is protected”. Professor Dame Jenny Harries, UKHSA Chief Executive, stated that the vaccine “offers huge opportunities to prevent severe illness in those most vulnerable to RSV”. This will “protect lives and ease winter pressures for the NHS”.
“UKHSA has provided critical scientific information to evidence the benefits of a national RSV immunisation programme and so the rollout of the vaccine is a truly positive moment for the public’s health.”
Will the procurement of an “effective vaccine” and a programme to protect both infants and older people, UKHSA is “working rapidly” with the NHS and Local Authority colleagues to prepare for September.
“Please do come forward if you are eligible.”
RSV remains a priority theme on the Congress agenda this October, so do join us to contribute to discussions, and don’t forget to subscribe to our newsletters for more vaccine updates.
by Charlotte Kilpatrick | Jul 16, 2024 | Global Health |
A paper in Nature Communications in July 2024 presents the concept of a “zoonotic web”, describing the “complex relationships” between zoonotic agents, hosts, vectors, food, and environmental sources. Created from a dataset of naturally occurring zoonotic interactions in Austria by a team from Complexity Science Hub (CSH), the web offers insights into zoonotic sources and spillovers. The authors present a “flexible network-based approach” to bring understanding of zoonotic transmission chains and facilitate the development of “locally relevant” One Health strategies against zoonoses.
Understanding interfaces
Zoonoses are caused by pathogens that are “naturally transmissible” between humans and animals; zoonotic agent transmission is enabled at “interfaces” where humans and animals, or animal products, interact. The researchers acknowledge that “approximately 99% of endemic zoonotic infections in humans” originate from domesticated animals in anthropogenic environments. Over 60% of human emerging infectious diseases (EIDs) are zoonotic, with more than 70% of these zoonotic emergences caused by pathogens with wildlife origin.
“However, the full host breadth of endemic and emerging zoonotic agents, as well as their animal and environmental reservoirs are rarely identified nor mapped.”
As interactions in “most” zoonotic disease systems occur among multiple animal host species and environmental sources and involve multiple infectious agents, the authors state that exploring disease dynamics “necessitates considering the complex ecology of the interactions”. However, a “lack of datasets” makes it hard to follow a transdisciplinary perspective. Additionally, network approaches tend to focus on the host-pathogen relationships over other sources of zoonotic infection, such as contaminated environment or food.
“A comprehensive understanding of circulating zoonotic agents, their hosts, vectors, food and environmental sources, and the key interfaces where spillover events may occur is essential for developing effective integrated One Health monitoring, prevention, and control of zoonoses.”
Zoonotic and emerging diseases have consequences on “multiple aspects” of society, but it is possible to predict the establishment of reservoirs, understand the facilitators of spillovers, and prevent such spillovers at the source through enhanced monitoring efforts and data collection. The authors describe a “pressing need” to develop analytical tools to “optimise surveillance strategies” that are “tailored” to regional or national contexts and conduct national studies.
“Bridging this gap is crucial for developing effective, locally relevant strategies to monitor and mitigate potential changes in spillover risk that could impact human and animal health.”
The study
The study is based in Austria, which has a “growing population” of nine million people. It is home to around 45,870 fauna species, of which 626 are vertebrates, including 110 mammalian and 418 avian species. 35% of 3.9 million Austrian households have pets and the country has ~53,300 cattle, 1 million pigs, and 5 million poultry. 133,000 hunting permits are issued each year. These figures demonstrate the significance of the “human-animal interfaces at the national scale”.
Although the country follows various European and national regulations on epidemiological surveillance and responses, the authors suggest that official figures “tend to overlook” non-regulated zoonotic agents circulating in the territory that present a public health risk. They conducted a literature search over 47 years of publications to generate a real-world network that describes the “web” of zoonotic interactions in Austria and to characterise the “various interfaces” through while spillover might occur.
The idea of a “zoonotic web” is presented as a “representation of zoonotic actors at human-animal-environment interfaces” to be used for One Health approaches. The researchers used it as a bipartite network and turned it into a one-mode projection representing the network of zoonotic agent sharing among zoonotic sources, weighting relationships (edges) between the sources (nodes) by the number of agents they shared.
Findings
The authors find that “most” zoonotic agents are “capable of infecting both human and diverse animal species across various taxa, while evolving within multi-source, multi-agent ecological communities”. This is “consistent” with “established principles in the parasite community ecology”. They suggest that the analysis of the zoonotic web provides “greater value” for studying potential zoonotic transmission chains than the host-pathogen network approach.
In their investigations of the centrality of zoonotic sources, they identified that certain sources “play a disproportionate role in the sharing of zoonotic agents”. They highlight the “crucial role” of arthropod vectors and foodstuffs in the risk of zoonotic disease emergence and transmission through the web, which offers potential targets for One Health surveillance programmes.
A key outcome is that ten genera of zoonotic agents constituted 41% of the published research on zoonotic diseases in Austria; seven of these involve agents subject to compulsory surveillance and reporting in humans and/or animals. This “underscores an imbalance” in research interest, which the authors attribute to funding opportunities and global- or national-level prioritisation.
“Bias may lead to a skewed assessment of the overall zoonotic risk, especially concerning potentially ‘neglected’ zoonoses such as certain helminth infections.”
Between 1975 and 2022, eight zoonotic agents emerged in Austria. Although there is “often an emphasis” on viral emergence, this research offers a “different perspective”: six out of eight emerging pathogens in Austria were bacteria and helminths.
“This highlights the importance of broadening our focus beyond viral threats and acknowledging the substantial role that bacterial and helminthic pathogens play in the landscape of emerging diseases.”
Another observation is that four emerging zoonoses are transmitted by arthropod vectors; as climate change and globalisation evolve, the authors identify a “growing likelihood” of new arthropod species populations becoming established in Austria. This increases the risk of future EID events.
The researchers express surprise at finding that no COVID-19-related publications concerning human cases describe it as a zoonotic disease, despite SARS-CoV-2 being notifiable for both humans and animals. Additionally, the publication that investigated SARS-CoV-2 in Austrian animals did not mention zoonotic potential.
The importance of studying the source-source network of zoonotic agent sharing to reveal indirect interactions is highlighted by the researchers. They present the example of an agent that is found in two sources, where its prevalence in one could affect the other, but acknowledge that indirect interactions could “lack epidemiological significance”. They show that the zoonotic agent sharing network in Austria is “organised” into six communities.
- Primarily comprising central hosts having higher values of centrality in the unipartite zoonotic agent sharing network and generally living in proximity to humans or having frequent interactions with humans. This community includes livestock, companion animals, synanthropic species, game species, and captive primates.
- Encompassing diverse reptiles and amphibians, including non-traditional pet (NTP) species and wild boar.
- Consisting of various avian taxa, including birds of prey, ducks, waterfowl, gamebirds, chickens, and pigeons – the hosts were broadly designated, lacking specific scientific nomenclature.
- Including various food products and environmental matrices related to food production as well as public lavatory and Meleagris gallopavo (turkey).
- Featuring mostly clustered West Nile virus (WNV) hosts and Usutu virus (USUV) hosts, including various bird species, the vector Culex, and horses.
- Representing USUV hosts and exclusively including bird species.
The highest risk of zoonotic spillover is identified from sources within the first community, where the most zoonotic agents are shared. Another observation is that a “limited number of highly connected zoonotic agents” in the bipartite zoonotic web, including USUV, S. enterica, WNV, and Influenza A, could “at least partly” drive zoonotic agent sharing community assemblage.
From the grouping of most food products into one community, the authors infer that anthropogenic activities, especially those that relate to food processing and transformation, might further influence the pattern of assembly within zoonotic source communities. This indicates that a combination of local epidemiological, ecological, human-related, and behavioural factors informs zoonotic agent sharing community patterns.
The researchers highlight the presence of central zoonotic sources in the network, with a higher number of interactions with zoonotic agents. These act as “hubs” or “bridge different zoonotic source communities” to act as “connectors”. For example, some livestock species, companion animals, wildlife, and vectors act as “bridge hosts” through which zoonotic agents can potentially spillover from maintenance populations or communities to target “protected” populations.
Implications
The authors offer a cross-disciplinary method for “unveiling the intricate web of zoonotic interactions involving multiple sources and infectious agents within an ecological system”. This approach also enables the identification of “influential” agents and sources that might have “epidemiological significance”. It could be applied in various settings to expose knowledge gaps and areas where understanding “may not always reflect on-the-ground realities”.
“This work emphasises the need for further modelling and empirical studies to explore how maintenance is influenced by multiple source-agent interactions. Establishing efficient and context-adapted One Health network-based surveillance and control strategies requires supplementing the network analysis with multi-source data, ensuring a holistic, multidimensional understanding of the zoonotic web to unravel the complex dynamics of zoonotic transmission chains.”
Commenting on the paper, CSH’s Dr Amélie Desvars-Larrive suggests that it started with the intention of characterising and visualising the zoonotic interfaces in Austria. From this came the first comprehensive overview of zoonotic pathogen transmission, a “complex system”. This could be useful for zoonosis surveillance programmes.
“With our interactive map, we aim to educate and spark curiosity. While we all encounter various pathogens, only a few lead to illness, so there’s no need for excessive concern.”
However, Dr Desvars-Larrive emphasises the importance of promoting awareness and demanding better data availability.
“We’re only seeing the tip of the iceberg in our data – only those zoonoses that have been diagnoses. For instance, leptospirosis, still relatively rare in Austria, can mimic flu-like symptoms. If not clearly diagnosed as leptospirosis, it won’t show up in the data.”
Therefore, this network is a good starting point to “facilitate the development of One Health strategies against zoonoses”.
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by Charlotte Kilpatrick | Jul 16, 2024 | Global Health |
In July 2024, Grattan Institute shared a report on the importance of GPs in providing vaccination services. The authors, Peter Breadon and Anika Stobart, call for better government support for these “trusted experts” in delivering this service, such as increased investment or better data. Although there are other barriers to vaccination, Breadon and Stobart describe the role of GPs in closing the vaccination gap as “clearly crucial”. Their report presents specific recommendations to improve vaccination rates for GP patients, suggesting that the government should “level the playing field”.
Differing vaccination rates
“GPs are the foundation of Australia’s healthcare system. As well as diagnosing and treating many conditions, GPs give advice and treatment to prevent problems or stop them getting worse. This includes ensuring patients are up to date with their recommended vaccinations.”
The report begins by identifying a range in GP patient vaccination rates, with some GPs having “very low” adult vaccination rates and others exceeding expectations. These rates range from a two-fold difference for flu to a 13-fold difference for pneumococcal. The lowest coverage is linked to “disadvantaged areas”, “culturally and linguistically diverse backgrounds”, and “residential aged care”. This is concerning as these groups are “often” at “greater risk of severe illness”.
“Structural barriers to vaccination are often to blame for low vaccination, not individual, or cultural, attitudes towards vaccines.”
To determine variation in adult vaccination rates and which GPs might need “more targeted support”, the authors used data at patient and GP level. For COVID vaccination, the bottom 5% of GPs (around 1,600) had only 16% of their patients aged 65 and older up to date, less than one third of the average. Flu vaccination saw a two-fold difference, with GPs with lowest flu coverage having only 43% of their patients vaccinated compared to 90% for highest flu coverage.
Shingles had a four-fold difference, ranging from 5% to 22% on average; the top 5% had 85% of their patients up to date. However, pneumococcal had the “biggest disparity”. The bottom 5% of GPs had only 6% of their patients vaccinated, compared to the top 5% who had 82% of their patients vaccinated. This was a 13-fold difference.
“While some variation is inevitable, these differences are unacceptably large, especially for COVID and pneumococcal. They suggest the system is failing to give everyone good access to potentially life-saving preventative healthcare.”
Key barriers
The report identifies an “imbalance” in the health system, finding that “Australians who are more vulnerable to disease are less likely to get the high-quality, preventive care they need”. Factors such as proficiency in English, where someone lives, or highest level of education attained, have a “big effect”. For example, people who speak a language other than English at home or “do not speak English proficiently”, are “much less likely” to be up to date with vaccinations. People born in North Africa and the Middle East were between 15 and 25% less likely to be vaccinated than people born in Australia, and being born overseas was “nearly always associated with lower vaccination”.
“These low vaccination rates could be due to a range of factors including discrimination, language barriers, lower health literacy, or higher rates of vaccine hesitancy. But because vaccination is lower for virtually all non-English language groups, and for migrants from almost all international regions, it is clear that the problem is not just about the beliefs or preferences of any specific cultural group.”
Other groups are also less likely to be vaccinated, including “older people with higher rates of economic disadvantage” and people with “lower levels of education”. Although people from “disadvantaged areas” suffer greater rates of chronic disease and are “more than twice as likely to die from potentially preventable causes”, people in “outer regional and remote areas” are less likely to be vaccinated.
“Groups who need healthcare more having a greater risk of missing out is a systemic problem that goes well beyond vaccination”.
People in aged care are also at “significant risk” of severe illness and death from disease, but their vaccination rates are “far too low”. For example, only 38% of aged care residents were up to date with COVID vaccinations in June 2024. Almost 100 aged care facilitates had less than 10% of residents vaccinated against COVID in a year, and a quarter of facilities have “less than half” of their residents vaccinated. These rates are “far below” those of “similar countries” – the authors refer to Ireland and England as examples.
Another trend is that people who visit a GP “frequently, regularly, or who visit more expensive GPs, are more likely to be vaccinated”. People who visit a GP “frequently” are up to 27% more likely to be vaccinated than those who don’t, and seeing a GP who charges more “increases your chances of being vaccinated” by up to 17%. While the report highlights a “range of barriers” to vaccination and recognises that they demand “structural changes to healthcare”, it suggests that “some” differences in GP vaccination rates could be attributed to differences in GP practices.
GP practices
Despite accounting for a “wide range” of barriers to vaccination, the report found that some GPs still have lower rates than might be expected. The authors infer that “other factors” may be contributing. These might include the effects of the primary care funding model, which has caused GPs to compress “increasingly complex care” into appointments that average around 15 minutes. They are “under pressure” to complete appointments quickly and “skip” preventive healthcare. Therefore, they may find it hard to make time for patients who are hesitant about vaccination, call in interpreters, or handover to a nurse (if there is one), to enable patients to get vaccinated.
Funding and regulatory barriers also mean that GPs might have “less support from a broader team”, such as nurses or allied health professionals. Thus, explaining vaccine risks and benefits or countering misinformation “often falls on the GP alone”. They also might have “different levels of focus” on vaccination; an Australian study found that GPs only initiate discussions about vaccinations in around 10% of consultations. There is also the possibility that GPs are “unaware of the latest vaccination information” as the guidance is “unclear and changing”. Finally, they may not “immediately” have information on a patient’s vaccination history on their software programmes.
What should be done?
“Australia’s health system can only get better and fairer if governments measure care and outcomes and strive to improve them at every level, using funding, data, and focused improvement support.”
A key concern for the authors is that GP clinics should be able to “choose a funding model” that “supports team care” and enables GPs to spend time with complex patients by combining appointment fees with a budget that is based on each patient’s level of need. This “blended” funding model is “common in other countries” and has been introduced by the federal government for some patients through “MyMedicare”. It should be expanded to other patients to increase funding for “older, poorer, and sicker patients”.
“This funding based on need not speed would give GPs the opportunity to provide preventive care to the patients who need it most.”
GPs should also be supported with “better information” on how their patient vaccination rates compare to their peers. The federal government could give Primary Health Networks data to share with GPs, even extending to pharmacies. As Primary Health Networks are “responsible for improving primary care”, they should also get new funding to “expand their work supporting GP clinics to boost vaccination”.
The authors emphasise that efforts to improve vaccination rates “cannot be one-size-fits-all” but should respond to different barriers with specific support. Breadon comments that “Australia urgently needs to lift its vaccination game”.
“Our report shows that the system is failing to give every Australian good access to potentially life-saving preventive healthcare.”
For more on the importance of adult vaccination strategies and approaches to encouraging uptake, 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 | Jul 15, 2024 | Global Health |
Côte d’Ivoire, the first country to roll-out the R21/Matrix-M vaccine, began vaccinations in July 2024 with the first child vaccinated in Abidjan. Malaria kills around 600,000 people a year in Africa and is the “leading cause of medical consultations” in Côte d’Ivoire. The vaccine was co-developed by the University of Oxford and Serum Institute of India with Novavax’s Matrix-M technology and received WHO prequalification in 2023.
Serum Institute of India (SII) has manufactured 25 million doses of the vaccine and has committed to scaling up to 100 million doses. The vaccine is offered at less than $4 per dose. SII’s production capability will enable fast and productive manufacturing, which will be “critical to stemming the spread of disease” and protecting the vaccinated. 656,600 doses have been received to vaccinate 250,000 children up to 23 months old across 16 regions. The vaccine has also been authorised by Ghana, Nigeria, Burkina Faso, and the Central African Republic.
This is the second malaria vaccine available in sub-Saharan Africa after RTS,S; both vaccines are “expected to have a high public health impact”. SII CEO, Adar Poonawalla, suggests that “reducing the malaria burden is finally within sight” after “years of incredible work” with partners at Oxford and Novavax.
“At Serum, we believe that it is every person’s right to have access to affordable and essential disease prevention. That’s why we have committed to producing 100 million doses of R21, which will protect millions of lives and alleviate the burden of this deadly disease for future generations.”
Serum is “thrilled” and “excited” by the continued collaboration and the opportunity to play a “leading role in eliminating a disease that has been so challenging to beat”.
A new era
Professor Adrian Hill, Director of the Jenner Institute at Oxford, describes the roll-out as “the start of a new era in malaria control interventions”. The “high efficacy” vaccine is now accessible at a “modest” price and “very large scale”.
“We hope that very soon this vaccine can be provided to all countries in Africa who wish to use it.”
Efforts from Gavi, WHO, UNICEF, the Global Fund, and partners are underway to prepare other countries for the deployment of this vaccine within wider malaria prevention and control strategies. Gavi’s support is expected to facilitate the introduction of the vaccine to 15 African countries in 2024, but more than 30 African countries have expressed interest in introducing it.
Dr Sania Nishtar, Gavi’s Chief Executive Officer, recognised that “Africa has borne the brunt of malaria for far too long”.
“Côte d”Ivoire has suffered more than most. With two safe and effective vaccines now available alongside other interventions, we have an opportunity to finally turn the tide against this killer disease.”
Novavax President and Chief Executive Officer John Jacobs agrees that this introduction is a “breakthrough in the fight to protect vulnerable children” from a “leading cause of death in the region”. It also “reinforc[es] our mission to create innovative vaccines that improve public health”.
“Novavax is proud of the contribution of our Matrix-M adjuvant in this vaccine and in making this moment possible, and value our continued collaboration with University of Oxford and Serum Institute of India, as well as the lifesaving work of WHO, Gavi, and UNICEF.”
We look forward to welcoming malaria experts, including Professor Hill, to the Congress in Barcelona this October to explore strategies and opportunities against the disease. Get your tickets to join us here and don’t forget to subscribe for more vaccine updates.
by Charlotte Kilpatrick | Jul 15, 2024 | Global Health |
In July 2024 WHO and UNICEF shared that data on global childhood immunisation from 2023 reveals that 2.7 million additional children were left “un- and under-vaccinated” compared to pre-pandemic levels in 2019. The WHO and UNICEF estimates of national immunisation coverage (WUENIC) provide the “largest and most comprehensive” dataset on immunisation trends across vaccination against 14 diseases. The trends suggest that immunisation has stalled at insufficient levels, highlighting the need for “ongoing catch-up, recovery, and system-strengthening efforts”.
DTP coverage
The number of children who received three doses of the diphtheria, tetanus, and pertussis (DTP) vaccine in 2023, which is a key marker for global immunisation coverage, stalled at 84% (108 million). Unfortunately, the number of children who did not receive a single dose of the vaccine increased from 13.9 million in 2022 to 14.5 million 2023. A further 6.5 million children did not complete their third dose of the DTP vaccine.
“More than half of unvaccinated children live in the 31 countries with fragile, conflict-affected, and vulnerable settings, where children are especially vulnerable to preventable diseases because of disruptions and lack of access to security, nutrition, and health services.”
WHO and UNICEF are concerned that, while coverage has “remained largely unchanged since 2022”, it has not returned to 2019 levels. This reflects “ongoing challenges with disruptions in healthcare services, logistical challenges, vaccine hesitancy, and inequities in access to services”.
Measles outbreaks
The data also show that vaccination progress against measles stalled, which puts almost 35 million children at risk with “no or only partial protection”. In 2023, only 83% of children worldwide received their first dose of the measles vaccine. Although the number of children who received a second dose “modestly increased” from the previous year to reach 74% of children, the figures “fall short” of the 95% coverage required to prevent outbreaks, avert disease and deaths, and achieve measles elimination goals.
The effects of this are already being seen as measles outbreaks have struck 103 countries in the last five years, putting around three-quarters of the world’s infants at risk. This is attributed to low vaccine coverage (80% or less), with 91 countries with “strong” measles coverage not experiencing outbreaks.
WHO Director-General Dr Tedros Adhanom Ghebreyesus, described measles outbreaks as the “canary in the coalmine, exposing and exploiting gaps in immunisation and hitting the most vulnerable first”.
“This is a solvable problem. Measles vaccine is cheap and can be delivered even in the most difficult places. WHO is committed to working with all our partners to support countries to close these gaps and protect the most at-risk children as quickly as possible.”
HPV vaccine progress
Although overall trends may be disappointing, the data also reveal some “brighter spots in immunisation coverage”. This includes the “steady introduction” of new and under-utilised vaccines, such as for human papillomavirus (HPV), meningitis, pneumococcal, polio, and rotavirus disease, particularly in the 57 countries supported by Gavi. Indeed, Gavi-supported countries like Bangladesh, Indonesia, and Nigeria, are driving increased levels of protection with the introduction of the HPV vaccine. The percentage of adolescent girls globally who received at least 1 dose of the HPV vaccine increased from 20% in 2022 to 27% in 2023.
Dr Sania Nishtar, CEO of Gavi, suggests that the HPV vaccine is “one of the most impactful vaccines” in the Gavi portfolio.
“It is incredibly heartening that it is now reaching more girls than ever before. With vaccines now available to over 50% of eligible girls in African countries, we have much work to be done, but today we can see we have a clear pathway to eliminating this terrible disease.”
However, HPV vaccine coverage remains “well below” the 90% target for eliminating cervical cancer as a public health problem; it is reaching only 56% of adolescent girls in high-income countries and 23% in low- and middle-income countries. UNICEF research suggests that 75% of people who use its digital platform for young people are “unaware or unsure” of what HPV is. When informed about the virus and its links to cancers, as well as the existence of a vaccine, 52% of respondents indicated willingness to receive the vaccine but identified financial constrains (41%) and lack of availability (34%) as barriers.
IA2030
Although “modest progress” is being made, the data suggest a need to “accelerate efforts” to meet the Immunisation Agenda 2030 (IA2030) targets of 90% coverage and no more than 6.5 million “zero-dose” children by 2030. The IA2030 Partnership Council is demanding increased investment in innovation and continued collaboration.
UNICEF Executive Director Catherine Russell commented that “many countries continue to miss far too many children”.
“Closing the immunisation gap requires a global effort, with governments, partners, and local leaders investing in primary healthcare and community workers to ensure every child gets vaccinated, and that overall healthcare is strengthened.”
To join us at the Congress in Barcelona for more on boosting global immunisation progress, get your tickets here, and don’t forget to subscribe to our weekly newsletters for more vaccine updates.
by Charlotte Kilpatrick | Jul 12, 2024 | Global Health |
A study in PLOS One in June 2024 explores the “ongoing workforce issues” caused by a “significant incidence of Long COVID” in the population. Researchers at the University of Birmingham and Keele University found that people with Long COVID symptoms lasting longer than 28 weeks, which is over the maximum period of statutory employment protection in the UK, are more likely to leave employment. They suggest that the extension of Statutory Sickness Pay and “greater flexibility” to manage partial (returns to) work would “help preserve employment and mental health”.
Long COVID and employment
Long COVID is a “long-term debilitating illness” that follows infection with the SARS-CoV-2 virus. Symptoms are “multidimensional” and can include chronic or episodic physical, cognitive, or mental illness. This causes “significant limitations on daily activities”. An estimated 65 million people worldwide have experienced Long COVID, with those between the ages of 45 and 54 at greatest risk. The authors state that the “higher prevalence” of Long COVID in working-age people and the “withdrawal of public vaccination programmes” for people under 65 years in the UK mean that Long COVID is “set to have a significant and lasting impact” on health, employment, and earnings.
Three “contrasting, although not mutually exclusive” effects on employment outcomes are identified:
- Leaving the labour market, either on a permanent or temporary basis until health may recover
- Reducing hours worker in order to accommodate health problems, including sickness absence
- Continuing in existing work arrangements, with possible consequences for health and wellbeing
Although there are “large numbers” of the population reporting Long COVID and a “sharp rise in economic inactivity” has been observed, there is little evidence on the potential workforce consequences. Therefore, the authors sought to address the knowledge gap and provide evidence on the effects of Long COVID on workers with data from the UK.
The study
The researchers used a large national longitudinal survey of people 16 years and older and multi-variate panel regression modelling to estimate how the development of Long COVID has changed employment and in-work experiences. They found that having short COVID (symptoms <5 weeks) or Long COVID 5-28 weeks, the duration covered by Statutory Sickness Pay under employment protection law, increases odds of not working while still being in employment. For people with Long COVID beyond the maximum period of employment protection in the UK, there was not a relationship with working zero hours. The effect of Long COVID on working hours appears to be due to workers not working at all, rather than working reduced hours. Previous research shows that working fewer hours can help accommodate a work-limiting disability, so the authors infer a “lack of accommodation by employers of Long COVID at work”.
The paper also considers the in-work experiences of those with Long COVID, finding “large negative effects” on workers’ general mental health and happiness for the Long COVID group with symptoms lasting 29+ weeks. Findings for the group with symptoms lasting between 5 and 28 weeks are “more mixed”, which implies that “negative impact on mental health is mediated by earnings and the possible job characteristics associated with high/lower incomes”.
Policy implications
For the UK, the researchers suggest that the extension of Statutory Sickness Pay and greater flexibility would “help to stem the flow out of employment of those with Long COVID”. Financial support for employers would also help “preserve employment”. Dr Darja Reuschke, Associate Professor at the City-Region Economic Development Institute, University of Birmingham, recognised that “Long COVID is still a fairly new illness for society to deal with”. However, it is one that “does not seem to be going away any time soon”.
“By the end of March 2024, there were an estimated 2 million people in England and Scotland experiencing Long COVID symptoms. This undoubtedly will have an impact on the working population, particularly for those whose symptoms continue past statutory sick pay.”
Dr Reuschke suggests that extending sick pay and “giving people greater flexibility to manage phase returns to work” would mitigate the risk of losing workers.
“Financial support for employers to maintain employment until recovery from Long COVID would help to preserve employment and tackle the rising level of inactivity in the UK, something the new Labour government has said it is keen to realise.”
Professor of Regional Economic Development Donald Houston states that the study “shows that those with Long COVID who can work, want and do continue to work”.
“Working zero hours is associated with people who fall within the statutory sick pay/leave limits, and then after that people go back to work if they can, or leave work either through resignation or redundancy.”
Professor of Regional Economic Development and Policy at Keele University, Paul Sissons, commented on the “significant impact” of Long COVID on individuals’ employment outcomes.
“The research highlights important gaps in the sickness benefits system, but also points to the importance of the role of employers in supporting the management of long-term conditions in the workplace. Our analysis suggests that Long COVID poses a twin challenge to employers of providing adaptations and flexibility to help employees manage the physical symptoms, as well as better supporting mental health and wellbeing.”
To explore “outstanding questions” around Long COVID, why not join us at the Congress in Barcelona this October for a panel with global health experts? Don’t forget to subscribe to our weekly newsletters here.
by Charlotte Kilpatrick | Jul 10, 2024 | Global Health |
In July 2024 CEPI shared a blog post about the outbreak of H5N1 bird flu in cattle in the US, offering insight into its approach towards this growing threat. The authors, Kate Kelland and Jodie Rogers, acknowledge that the identification of the virus in these mammals is “raising questions” about the potential for the highly pathogenic influenza virus to become a human epidemic threat. As CDC recently confirmed the fourth case of human infection with H5N1, health experts are urging caution and sensitivity to the changing risk to humans.
Calm urgency
Dr Nicole Lurie, CEPI’s Executive Director for Preparedness and Response, is quoted emphasising the importance of being “ahead of the curve” to contain an outbreak.
“CEPI’s approach for the moment is one of calm urgency.”
Dr Lurie likens this stage of preparation to “putting our shoes on in case we need to start running”. CEPI is a “no regrets” organisation, hoping to step up as swiftly as required to any change in the threat level. It has therefore assembled a cross-departmental group of experts to monitor the outbreak and initiate pre-emptive steps to “put the world ahead” of H5N1.
Pre-emptive steps
Some of the steps that CEPI is taking include investigating potential H5N1 vaccine development with computer-assisted design and exploring the potential role of mRNA. These approaches have potential to produce a “better” vaccine or one that can be manufactured faster than the traditional egg-based approach to flu vaccines.
CEPI is also working with partners in the pandemic preparedness and response space to plan potential collaborations to improve preparedness and increase equitable access to vaccines. It is also communicating with its network of vaccine manufacturers in the Global South to prepare to navigate any barriers to production scale up of H5N1 vaccines.
Access comes first
As always, CEPI highlights the need to “advocate for equitable access”. Kelland and Rogers reflect that currently available doses are “limited” and already going to high-income countries. They are concerned that the access failings of the COVID-19 pandemic will be repeated, with low- and middle-income countries “pushed to the back of the queue”. Dr Lurie shares an internal estimate that 50% of existing supply is “already tied up in contracts or potentially subject to export controls”.
“Vaccine equity should be a forethought, not an afterthought. The goal of equity does not necessarily need to compete with the need for sovereign nations to protect their populations.”
Staying flexible
CEPI is prepared to “ramp up its response” if the situation changes but is also ready to use relevant knowledge and data to improve understanding of H5N1 and other highly pathogenic flu viruses if activity isn’t required.
“Taking these steps now will also allow our partners to test out how they could better prepare for future viral disease outbreaks.”
This “preparedness thinking” is “central” to the 100 Days Mission.
We are excited to welcome senior CEPI representatives back to the Congress in Barcelona this October to share their expert insights on the role of vaccines in pandemic preparedness and response. Do join us by getting your tickets here, and don’t forget to subscribe for weekly vaccine updates here.
by Charlotte Kilpatrick | Jul 10, 2024 | Global Health |
In July 2024, days after announcing the death of two elephants from Elephant Endotheliotropic Herpesvirus (EEHV), Dublin Zoo announced that Asha, a 17-year-old Asian elephant, has tested positive for EEHV. The zoo stated that a dedicated veterinary team is “working tirelessly” to provide the “best possible care”. Just a few weeks earlier, in June, Houston Zoo announced the “first-ever” mRNA vaccination of their 40-year-old Asian Elephant with a vaccine developed by Baylor College of Medicine and Colossal against the disease.
What is EEHV?
Elephant Endotheliotropic herpesvirus (EEHV) is described as a “devastating” viral disease that affects both Asian and African elephants. It can cause lethal haemorrhagic disease and is associated with “massive levels” of virus in multiple organs. Most lethal infections in Asian elephants are caused by the EEHV1A strain.
Vaccine efforts
A new mRNA vaccine, designed to expose elephants to viral proteins to enable an immune response, is the result of efforts by Dr Paul Ling at Baylor College of Medicine and Houston Zoo with the support of Colossal. Preclinical trials have had positive results, which has paved the way for the vaccination of Houston Zoo’s Tess. Tess will be monitored to evaluate antibody levels in her blood and assess side effects or adverse reactions. If this is successful, Dr Ling hopes to take the vaccine to the wider population of elephants in human care before applications with animals in the wild.
“It quickly became evident that the mRNA solution was going to be feasible, so we prioritised implementation of that approach. We are much further along today than we would have been without Colossal’s scientific support, research teams, and funding.”
Colossal provided “advanced” technology tools, research support, and funding. Its CEO and co-founder, Ben Lamm, highlighted the importance of stopping animals “on the brink of extinction” from dying.
“I’m glad we could help accelerate and shorten this multi-decade journey with EEHV. We felt that there was not enough advanced technology or funding going into this work.”
Elephants are “incredibly intelligent keystone species” that are “critical to their ecosystems”, so Lamm is proud of the “incredible collaboration” and “thrilled” at Colossal’s role in the partnership. Chief Animal Officer Matt James has witnessed elephants suffering with EEHV “time and time again”.
“To be able to get a vaccine into the world that can stop that sort of senseless loss means everything to me. This is why I joined Colossal. I know we can work faster, and smarter, to save species on the brink of extinction: this is proof.”
For more on efforts to improve animal health and wellbeing with vaccines, why not join us at the Congress in Barcelona this October, or subscribe to our weekly newsletters here?
