If there’s a question most people are asking themselves now, that probably is when the coronavirus pandemic will be over and lockdowns can be lifted or at least relaxed. Well, better get comfortable, as this will be a long ride.
The World Health Organization (WHO) said the number of newly reported cases across the world reached a daily record this week with over 100,000 new cases on Tuesday. This means “we still have a long way to go in the pandemic,” WHO Director-General Tedros Adhanom Ghebreyesus said.
Nearly two-thirds of the cases were from just four countries, the WHO, said. These are the US, Russia, Brazil, and the UK. The US was the one to report the highest number of new cases, 45,251, followed by Brazil, with 13,140 cases. Almost five million cases and 325,000 deaths have been registered since the pandemic originated in China five months ago.
“We are very concerned about rising cases in low- and middle-income countries,” Tedros said. “The pandemic has taught and informed many lessons. Health is not a cost. It’s an investment. To live in a secure world, guaranteeing quality health for all is not just the right choice. It’s the smart choice.”
At the conference, Tedros anticipated countries will have to manage their activity around the coronavirus for the foreseeable future, with some experiencing a decline in the number of infections while in others the virus will resurge. This means there will be “no going back to business as usual,” according to Tedros, adding the virus is still “extremely dangerous.”
The new record of cases comes at the time of a dispute between the WHO and US President Donald Trump, who has accused the organization of mishandling the pandemic and leaning towards China. Trump reignited the conflict this week, threatening to withdraw from the WHO and withhold funding.
Mike Ryan, executive director of WHO’s health emergencies program, said funding from the US goes to a program that helps countries all over the world in “all sorts of fragile and difficult settings.” This means now the WHO will have to work with “other partners” to make sure the funds “can still flow,” Ryan said.
Meanwhile, Teros said he has received a letter from Trump, but didn’t want to comment further. He said he was committed to accountability and would carry out a review into the response to the pandemic. A review has been asked by member states and led to a resolution about being passed by consensus this week.
“I said it time and time again that WHO calls for accountability more than anyone. It has to be done and when it’s done it has to be a comprehensive one,” Tedros said of the review, not specifying when it would be done. Meanwhile, Ryan said reviews are usually done after emergencies are over.
The WHO representatives also referred at the press conference to the use of hydroxychloroquine, a medicine for malaria that has been mentioned in the media as a potential treatment for coronavirus infections. Ryan said people should avoid using it as there’s no evidence of effectiveness in the treatment of the virus
Reacting to the new numbers of cases of coronavirus, Trump said it is “a badge of honor” that the US has the world’s highest number. “I look at that as, in a certain respect, as being a good thing because it means our testing is much better,” he said at the White House.
Despite the US has done more tests in volume than other countries, it’s not the number one per capita, according to Our World in Data, a scientific publication based at Oxford University. The US ranks 16th global terms of tests per 1,000 people, ahead of South Korea.
If there’s one thing that’s needed to deal with a pandemic, that’s global cooperation to create a medical response. But that doesn’t seem to be on the plans of the United States government.
The World Health Organization (WHO) is starting an international project involving countries, industry groups, and non-governmental organizations to develop and produce drugs, vaccines, and tests for COVID19 — without the participation of the US.
“There will be no U.S. official participation”, a spokesman for the U.S. mission in Geneva told Reuters. “We look forward to learning more about this initiative in support of international cooperation to develop a vaccine for COVID-19 as soon as possible.”
The WHO is the UN agency responsible for global public health. It has 194 member states, and aims to “promote health, keep the world safe, and serve the vulnerable.” It is involved in vaccination campaigns, health emergencies, and supporting countries.
The initiative headed by the WHO, so far being called Access to COVID-19 Tools Accelerator, will seek to ensure global access to the medical products, making them available to both rich and poor populations alike.
The coronavirus pandemic has so far infected more than 2.7 million people across the globe and claimed approximately 191,000 lives. In the US, a total 986,000 cases have been so far reported as well as 55,000 deaths.
“The world needs these tools, and it needs them fast,” WHO Director-General Tedros Adhanom Ghebreyesus said in the presentation of the initiative. “Past experience has taught us that even when tools are available, they have been not been equally available to all. We cannot allow that to happen.”
Nevertheless, the project is in its early stages. Countries and organizations have been encouraged to start making pledges, hoping to get initial funding worth $8 billion. When that happens, other milestones will be announced, European Commission President Ursula von der Leyen said.
The aim of the project is to develop a voluntary pool to collect patent rights, regulatory test data, and other types of information that could be helpful to develop drugs, vaccines and tests. But it’s not clear yet how will this be instrumented among the members of the initiative.
Many have so far said yes to the project, such as the UK, France, South Africa, the World Bank, the UN, the Bill and Melinda Gates Foundation, the Global Fund to Fight AIDS, Tuberculosis and Malaria, Coalition for Epidemic Preparedness Innovations and the International Federation of Pharmaceutical Manufacturers.
The decision of the US not to participate in the initiative follows a similar move by the government to stop funding the WHO. The agency has “failed in its basic duty” in response to the coronavirus outbreak, US President Donald Trump said last week.
The health agency warned last week that the “worst is yet ahead of us” in the coronavirus outbreak, as some European and Asian countries started to relax the lockdown measures. Trump has repeatedly said the economy should be reopened as soon as possible.
In what could be seen as a warning to countries currently easing their lockdowns, the World Health Organization (WHO) warned that the “worst is yet ahead of us” in the coronavirus outbreak — asking for cooperation and global solidarity.
The WHO Director-General Tedros Adhanom Ghebreyesus didn’t specify why he believes the outbreak that has infected some 2.5 million people and killed over 166,000 could get worse. In the past, he had warned over the spread of the virus in Africa, with a less developed health system.
“Trust us. The worst is yet ahead of us,” Tedros told reporters from WHO headquarters in Geneva. “Let’s prevent this tragedy. It’s a virus that many people still don’t understand.”
Tedros compared the virus to the 1918 flu that killed 675,000 people in the US and tens of millions of people around the world. But he argued that the world now has the technology to prevent “that kind of crisis”.
The WHO has been on the defensive after President Donald Trump — the WHO’s biggest single donor — last week ordered a halt to U.S. funding for the agency, alleging that it botched the early response to the outbreak.
Trump insisted WHO had failed to adequately share “in a timely and transparent” way information about the outbreak after it erupted in China late last year. Nevertheless, Tredros said: “There is no secret in WHO because keeping things confidential or secret is dangerous.”
Tedros said U.S. Centers for Disease Control and Prevention staffers have been seconded to work with his agency, suggesting that was a sign of WHO’s transparency. “Having CDC staff (at WHO) means there is nothing hidden from the U.S. from day one,” Tedros said.
Some Asian and European governments have gradually eased or started relaxing “lockdown” measures like quarantines, school and business closures, and restrictions on public gatherings, citing a decline in the growth of COVID-19 case counts and deaths.
Germany reopened many of its shops this week and some of its schools from May 4. But strict curbs on social contact will remain in place and Germans will be encouraged to wear masks in shops and on public transport. Chancellor Angela Merkel said the country had achieved “interim success” in slowing the spread of the virus.
Meanwhile, France will unveil within two weeks a plan to progressively lift restrictions on travel and business that aim to curb the coronavirus epidemic, Prime Minister Edouard Philippe said.
In the US, Trump has urged governors to reopen their states despite experts’ warnings that doing so too soon would provoke a devastating resurgence of the virus. Dr. Anthony Fauci, the country’s leading infectious-disease expert, has said a vaccine is at least a year to 18 months away.
One day after President Trump announced that the US will stop funding the World Health Organisation (WHO), its Director-General Dr. Tedros Adhanom Ghebreyesus says he “regrets the decision” and calls again for global solidarity.
While Dr. Ghebreyesus held firm to his track record of tactfully reminding everyone of the importance of working together through the outbreak, others were much more vocal in their criticism. President Trump’s decision has been called “dangerous, short-sighted”, “politically motivated”, and “a typically petulant act”. I daresay I agree.
WHO’s the bad guy here?
“We regret the decision of the President of the United States to order a halt in funding to the World Health Organization,” Dr. Tedros Adhanom Ghebreyesus said in a press briefing Wednesday. “With support from the people and government of the United States, WHO works to improve the health of many of the world’s poorest and most vulnerable people.”
Dr. Ghebreyesus called again for global unity and continued focus on saving lives and fighting the common enemy, COVID-19, during the briefing.
The WHO was formed in the 1940s by the United Nations and supported by its member states, and received around 15% of all its funding from the US (a permanent member on the UN’s Security Council). After accusing it of “severely mismanaging” the outbreak, however, President Trump announced he will halt the funding until his administration has had a chance to review its response.
It is still currently unclear how this massive cut (one-sixth of all its resources) will impact the WHO, which is guiding the global response against COVID-19 while also fighting polio, measles, malaria, Ebola, HIV, tuberculosis, malnutrition, cancer, diabetes, mental health, and many other diseases and conditions, while further helping shore up national health systems and improve on their capabilities.
For context, here are the disease-combating efforts that the Trump administration is having a net positive effect on:
In his briefing, Dr. Tedros explained that the WHO is currently reviewing its budget and plans to work with its remaining partners to keep the body going as efficiently as possible. Furthermore, he noted that member states and independent bodies will review the WHO’s response to the pandemic “in due course,” as they have done after every major health event.
“No doubt, areas for improvement will be identified and there will be lessons for all of us to learn,” he said. “But for now, our focus—my focus—is on stopping this virus and saving lives. This is a time for all of us to be united in our common struggle against a common threat—a dangerous enemy. When we are divided, the virus exploits the cracks between us.”
People are criticizing this
I can’t shake the feeling that I’m watching a kid play at President — only it’s a spoiled kid, prone to episodes of Cartmanesque “I’m going home” mentality whenever something doesn’t go exactly his way.
Dr. Tedros himself has long asked politicians, the public, and the media to not “politicize COVID,” which would hurt our efforts to combat it. And he’s not shy about stating exactly why that fight is important.
“Please quarantine politicizing COVID,” he said in an April 8 press conference when asked about Trump’s previous criticism of the organization. “We will have many body bags in front of us if we don’t behave. When there are cracks at national level and global level that’s when the virus succeeds.”
“For God’s sake, we have lost more than 60,000 citizens of the world.“
Since April 8th, that figure has more than doubled, and there are now over 2 million confirmed cases of COVID-19 worldwide. The US is now the worst affected country with more than 632,000 cases and nearly 28,000 deaths.
Amid that backdrop, Dr. Robert Redfield, the head of the US Centers for Disease Control and Prevention, distanced himself from the decision, telling Good Morning America in an interview that the “CDC and WHO has had a long history of working together in multiple outbreaks throughout the world, as we continue to do in this one. And so, we’ve had a very productive public health relationship. We continue to have that.” There will be time to look at what happened with this outbreak, but only “once we get through it together.”
Both Bill and Melinda Gates tweeted warnings that this move is especially dangerous during a global health crisis.
Other experts are further weighing in on the decision, and they’re not happy at all about what they’re seeing. A simple google search will yield ample responses from individuals and institutions from around the world, but I’ll leave you with some of the more powerful ones I’ve found on The Science Media Center.
Prof Robert Dingwall, Professor of Sociology, Nottingham Trent University:
“The freeze on funding for WHO by the US government is a typically petulant act against an international organization that has sought to maintain its integrity and impartiality rather than to bow to President Trump’s transient and volatile prejudices.”
Dr. Peter Piot, the director of the London School of Hygiene & Tropical Medicine:
“Halting funding to the WHO is a dangerous, short-sighted, and politically motivated decision, with potential public health consequences for all countries in the world, whether they are rich or poor.”
Dr. Gail Carson, director of Network Development at ISARIC (International Severe Acute Respiratory and Emerging Infection Consortium) at the University of Oxford:
“Let’s hope President Trump and the review team realize quickly that now is not the time for division and potentially weakening the UN authority on health who are busy coordinating the global response to the pandemic. Look at facts, and there is plenty of evidence of all the good WHO has done during this pandemic.”
Joshua Moon, a senior research fellow at the Science Policy Research Unit, University of Sussex Business School:
“To see Trump threatening to pull funding from WHO in the middle of a pandemic is truly heartbreaking. The WHO has received so much criticism in the past decade surrounding its role in various public health emergencies. I have been one of those critics myself. However, this attack on WHO is a purely political move designed to distract and pander to Trump’s base.”
“At its core: the loss of US funding for WHO is a huge problem that will impact the response to COVID-19 globally, invite new and potentially unaccountable actors into the position of power that the US previous held, and is a contemptible falsehood being peddled by a politician who in my opinion is trying to hide his own mistakes from his supporters.”
Stephen Griffin, a medical professor, and expert at viral diseases at the University of Leeds:
“This most recent intervention in public health policy by President Trump is perhaps one of the least productive, most short-sighted, self-motivated, and hypocritical acts I have ever witnessed. As far as I can ascertain, it has no foundation in reality. The situation in the US and the world over amounts to a crisis, and one in which we must stand together. WHO is perhaps one of the best means of achieving this and deserves the support and respect of all countries.”
I agree with each and every one of them. The WHO definitely isn’t perfect, but it has always been committed to improving itself and learning from its shortcomings, as evidenced by their openness to reviews from member states. The WHO is perhaps the single greatest tool we have against the current pandemic. There aren’t enough votes in the whole USA to wash away the deaths it can prevent, Mr. President.
About 3.4% of confirmed cases of coronavirus have ended up in deaths — much higher than previously estimated and well above the death rate of the seasonal flu at about 1-2%, the World Health Organization (WHO) has announced.
The spread of the virus around the world can still be contained, said WHO director Tedros Adhanom Ghebreyesus. If we can implement strong action, there is still a chance of containing the virus.
“COVID-19 spreads less efficiently than flu. The transmission does not appear to be driven by people who are not sick, and it causes more severe illness than flu. There are not yet any vaccines or therapeutics, and it can be contained, which is why we must do everything we can to contain it,” Ghebreyesus said in a press conference.
The WHO head emphasized that there are 122 countries without a single coronavirus case and another 21 with only one person infected by the virus discovered last January in the city of Wuhan in China.
But at the same time, he warned about the “rapid depletion” of protective equipment such as masks and lenses to the expansion of the new coronavirus throughout the world, calling manufacturers to “urgently increase the production”
“WHO has sent nearly half a million personal protective equipment to 27 countries, but the reserves are rapidly depleted,” he added. The WHO estimated that only this March will require 89 million chinstraps, 76 million gloves and 1.6 million protective glasses.
China has reported 90,893 cases (including 3,110 deaths), while outside that country there are 1,848 cases of coronavirus. 80% of the latter are concentrated in only three countries: Italy, South Korean and Iran, now challenged by a lack of protective equipment for medical personnel.
Ghebreyesus urged governments to continue implementing strong action but also urged manufacturers of protective gear (masks, gloves, and goggles) to increase production.
Data from the Chinese government shows that the mortality rate in the country is about 3.7 percent, with most deaths reported in Wuhan and the surrounding province of Hubei. But, as the virus travels fast around the world, the spread appears to be slowing in China.
In Italy, 27 more deaths were reported in the last 24 hours, bringing the total number of diseased so far to 79. The government announced new measures to contain the spread of the virus such as classifying areas of the country based on the level of risk and ordering people to keep a distance of one meter between each other.
Meanwhile, in the US, two people that died last week in Seattle were found to have been infected with the coronavirus. That increased the death toll in the US to nine, raising the alarm in the Seattle area, where all the deaths were detected. Local authorities are working to assess the risk in schools, medical centers, and businesses.
South Korea reported 516 new cases this week, bringing the total number of infected patients to 5,328, including 32 deaths. Nearly 90 percent of the patients were residents of Daegu, a southeastern city, and nearby towns. In Daegu, there were 4,006 patients, with more than half waiting for hospital beds.
In Japan, the number of infected people with the virus reached the 1,000 mark, with 706 of them being on the Diamond Princess cruise. Health Minister Seiko Hashimoto said the Olympics could be held later in the year, something dismissed by International Olympic Committee.
A higher fatality rate for Covid-19 is bad news, and it makes containment more important than ever. Despite the fact that there are already several Covid-19 clusters outside of China, WHO officials still believe we can contain the virus. It’s a story we’ve heard time and time again from Ghebreyesus: the window of containment is closing soon, but it is still open. For now, at least.
The directors of the World Health Organization (WHO) and The United Nations Children’s Fund (UNICEF) are personally convinced — we’re facing a global measles crisis.
Image credits Twitter Trends 2019 / Flickr.
Whether or not their respective agencies will issue an official warning is still under discussion. However, Henrietta Fore, the executive director of UNICEF, and Tedros Adhanom Ghebreyesus, the director general of WHO, issued a shared statement declaring their personal opinion that the world is beset by a measles crisis. The duo cite data showing a 300% overall increase in cases of this disease globally.
Less measles, please
“We are in the middle of a global measles crisis,” they together declared in a recent opinion piece for CNN.
By the time you finish reading this, we estimate that at least 40 people — most of them children — will be infected by this fast-moving, life-threatening disease.”
Measles is one of the most virulent diseases humanity has ever encountered. Before an effective vaccine was developed to guard us against the threat, it is estimated that virtually all children contracted this potentially-fatal disease by the time they turned 15.
So, you’ll be thrilled to know that measles is coming back in force around the world. In some areas, like Africa for example, measles cases have increased by a staggering 700% compared to 2018. The Democratic Republic of the Congo, Ethiopia, Georgia, Kazakhstan, Kyrgyzstan, Madagascar, Myanmar, Philippines, Sudan, Thailand, and Ukraine are currently in the throes of measles epidemics, they add.
Image via the CDC.
This data would certainly support the two’s opinion, especially when you factor in that the WHO estimates under 10% of all measles cases globally are reported. Even countries with high vaccination rates, like the US, Thailand, and Israel are seeing a surge in measles cases, likely due to localized gaps in vaccination coverage that impair herd immunity. With measles outbreaks in New York, Washington, California, and New Jersey, the United States has already counted more cases of this disease than all the 12 months of 2018 combined.
Fear of vaccines is at least part of the problem. Earlier this year, the WHO listed fear of vaccines as one of the most dire threats to public health in 2019. In areas like New York, whose recent measles outbreak has more to do with people refusing vaccines rather than a lack of access to them, vaccine fear is a leading cause of the disease’s spread.
“We welcome initial steps taken by digital companies such as Facebook, Amazon and YouTube to quarantine these vaccine myths,” Fore and Ghebreyesus write, “but it will take much more — not only from these online platforms but from governments, individuals and the health community — to make sure all children get their vaccines at the right time.”
It is estimated that measles vaccinations have saved some 20 million lives since the year 2000. The directors want to see vaccination efforts continue to bear fruit, but warn that unless we take a collective stand for science, health, and for vaccines, we will see many deaths caused by this disease in the near future.
An unofficial warning call has been issued. The only question now is: will we let it turn into an official, full-blown crisis?
Preliminary measles data for 2019 was published online by the World Health Organisation here.
Analysts from the World Health Organization (WHO) and the European Centre for Disease Prevention and Control (ECDC) recently reported that despite a decline in the incidence and mortality throughout Europe in people suffering from tuberculosis (TB), the trends among countries vary widely, and multidrug-resistant (MDR)-TB remains a major public health concern.
The joint WHO/ECDC report covers TB incidence and mortality for both the WHO European region, which includes 52 countries, and the 31-country European Union/European Economic Area (EU/EEA). In the WHO European Region, an estimated 275,000 new and relapse cases of TB occurred in 2017, for an average of 30 cases per 100,000 people. Eighty-seven percent of these patients (238,819) were notified. TB cases in the region represent nearly 3% of the global burden of the disease.
The absolute number of cases in the WHO European Region dropped by 15,000 from 2016, and the 4.7% average annual decline in incidence observed from 2008 through 2017 is significantly higher than the global rate of decline for TB incidence (1.8%).
TB mortality is also falling in the region. An estimated 24,000 TB deaths occurred in 2017 among HIV-negative patients in the WHO European Region, and the rate of 2.6 deaths per 100,000 people represents a 59% drop from 2008, when it was 6.3 per 100,000 people. The 10% annual decline over the past 5 years is notably higher than the 3.2% global decline observed from 2016 to 2017.
In the EU/EEA countries, 55,337 cases of TB were reported in 2017, for a notification rate of 10.7 per 100,000 people. The average annual decline in the notification rate was 4.5% from 2013 through 2017. The estimated number of TB deaths among HIV-negative patients in the EU/EEA was 4,000, down from an estimated 4,200 in 2016 and 6,700 in 2008. Although the decline in the notification rate is significant, the authors of the report point out that the 2030 target is a notification rate of 2.4 per 100,000.
Dr. Zsuzsanna Jakab, WHO
If the mean annual change in rate in low-incidence countries continues at that pace, they write, “calculations suggest the WHO target of TB elimination by 2050 in European low-incidence countries will not be met by approximately four-fifths of the countries currently in this group.”
Much of the gap in estimated incidence rates between the WHO European Region and the EU/EEA is driven by 18 high-prevalence non-EU/EEA countries (HPCs)—including Russia, Ukraine, Uzbekistan, Romania, Turkey, and Kazakhstan—that account for nearly 83% of the regional TB burden. The largest proportion of new and relapse TB cases comes from Russia (84,510, or 35.4%).
In addition, nine of the countries with the highest burden of rifampicin-resistant (RR)/MDR-TB burden—Azerbaijan, Belarus, Kazakhstan, Kyrgyzstan, Moldova, Russia, Tajikistan, Ukraine, and Uzbekistan—are non-EU/EEA countries. The MDR percentage among new bacteriologically confirmed pulmonary TB cases in the non-EU/EEA countries rose from 16.8% in 2013 to 18.1% in 2017. Extensively drug-resistant (XDR)-TB is also a rising problem in WHO European Region countries. XDR-TB cases rose from 575 in 2013 to 5,591 in 2017.
“TB is preventable and curable; the time to take action is now to end TB by 2030,” Zsuzsanna Jakab, MD, WHO regional director for Europe, said in an ECDC press release. “If we don’t act rapidly and decisively, the drug-resistant forms of the disease will increase their hold on Europe.”
New hope for drug-resistant TB
Up until now, an MDR-TB diagnosis spelled the start of a long and cumbersome two-year treatment plan for patients. New WHO recommendations for the treatment of MDR-TB involve safer and more effective drugs with reduced chances of severe side effects and a new treatment regimen for increased effectiveness.
Timely diagnostic tests are vital
Proper and fast diagnosis of TB is essential. The sooner a patient is diagnosed, the faster their treatment can begin, easing suffering and preventing further disease transmission. To improve diagnoses and ensure appropriate treatment approaches, it is also important to have capacity at the country level to rapidly detect drug-resistant TB.
Overall, the situation in the European Region is improving slowly to end TB by 2030. To reach the SDG target on TB, new intersectoral approaches are required, current tools need to be used more effectively and a people-centered approach to care is essential.
Yellow fever is spread by mosquitos. Image credits: James Gathany.
Dengue is a mosquito-borne disease that causes flu-like symptoms but can be lethal and kill up to 20% of those with severe dengue. In the last five decades, dengue has spread from being present in a handful of countries to being endemic in 128 countries, where about four billion people live. WHO has listed dengue as one of the top global health threats in 2019 alongside Ebola, global flu pandemic, HIV, antimicrobial resistance and many others.
Dengue cases have also increased 30-fold in this time period. In addition, more people are traveling than ever before and millions of travelers to endemic areas are also at risk of being bitten by the disease-carrying mosquitoes. A high number of cases occur in the rainy seasons of countries such as Bangladesh and India. Now, its season in these countries is lengthening significantly (in 2018, Bangladesh saw the highest number of deaths in almost two decades), and the disease is spreading to less tropical and more temperate countries such as Nepal, that have not traditionally seen the disease. An estimated 40% of the world is at risk of dengue fever, and there are around 390 million infections a year.
There is no specific treatment for dengue fever. For severe dengue, medical care by physicians and nurses experienced with the effects and progression of the disease can save lives – decreasing mortality rates from more than 20% to less than 1%. Maintenance of the patient’s body fluid volume is critical to severe dengue care.
(FILES) This file photo taken on April 4, 2016 shows a nurse showing vials of the anti-dengue vaccine Dengvaxia, developed by French medical giant Sanofi, during a vaccination program at an elementary school in suburban Manila.
The first dengue vaccine, Dengvaxia® (CYD-TDV) developed by Sanofi Pasteur was licensed in December 2015 and has now been approved by regulatory authorities in 20 countries for use in endemic areas in persons ranging from 9-45 years of age. In April 2016, WHO issued a conditional recommendation on the use of the vaccine for areas in which dengue is highly endemic as defined by seroprevalence of 70% or higher. In November 2017, the results of an additional analysis to retrospectively determine serostatus at the time of vaccination were released. The analysis showed that the subset of trial participants who were inferred to be seronegative at time of first vaccination had a higher risk of more severe dengue and hospitalizations from dengue compared to unvaccinated participants.
A new vaccine, TAK-003, is based on a live-attenuated dengue serotype 2 virus. Preliminary data through 15 months (Part 1 of the trial) showed that the vaccine met the primary efficacy endpoint of preventing virologically-confirmed dengue fever induced by any of the four dengue serotypes. In addition, the vaccine was found to be well-tolerated with no significant safety concerns.
“We are excited to publish the data in a peer-reviewed journal as quickly as possible,” said Rajeev Venkayya, MD, and President at Takeda. Part 2 of the trial will evaluate secondary outcome measures including vaccine efficacy by serotype, baseline serostatus and severity; long-term safety and efficacy evaluation (an additional 3 years) will be included in the third part of the study.
Takeda expects to file for licensure once Part 2 of the study is complete in each of the eight countries where its clinical trial took place: Brazil, Colombia, Panama, Dominican Republic, Nicaragua, Philippines, Thailand and Sri Lanka. The company plans to file in the U.S. and Europe within a year of filing in dengue-endemic countries, Venkayya said. Takeda and dengue experts are already planning ways to review the latest vaccine data with those regulators.
The Global Dengue & Aedes-Transmitted Diseases Consortium (GDAC), a group funded in part by drugmakers that works closely with WHO, scheduled a meeting for early March in Bangkok with regulators from at least six countries to take a first look at Takeda’s results, said Dr. In-Kyu Yoon, director of GDAC.
The World Health Organization (WHO) will include “gaming disorder” as a new mental health condition in the 11th edition of the International Classification of Diseases (ICD), released earlier today.
Image credits JD Hancock / Flickr.
The ICD is the end-all-be-all authority for doctors who are issuing a diagnostics. This document defines all known diseases, disorders, injuries, and related health conditions. It’s also the standard researchers use to quantify deaths, diseases, injuries, and symptoms. The document also affects us laymen — healthcare companies and insurers use the ICD as a basis for reimbursement.
Now, the WHO wants to include ‘gaming disorder‘ in the new edition of the ICD. This official recognition of the condition will raise awareness among doctors and healthcare networks, as well as improving the odds that “people who suffer from these conditions [will] get appropriate help.”
Dr. Vladimir Poznyak, a member of WHO’s Department of Mental Health and Substance Abuse, which proposed the new diagnosis to WHO’s decision-making body, said diagnosing gaming disorder comes down to three major features:
Gaming behavior that takes precedence over other activities. The extent of this behavior is such that all other activity is pushed to “the periphery.”
The second feature is an “impaired control of these behaviors.” In other words, even if a person suffering from gaming disorder experiences negative consequences from gaming, he is unable to change his behavior. Gaming continues unabated or even escalates. To establish a diagnosis for gaming disorder, a “persistent or recurrent” behavior pattern of “sufficient severity” needs to emerge.
Finally, this behavior needs to lead to significant distress and impairment in somebody’s personal life, family dynamics, social relationships or occupational functioning. The impacts of gaming disorder may include “disturbed sleep patterns, like diet problems, like a deficiency in the physical activity,” Poznyak adds.
All in all, these characteristics are very similar to what you’d use to determine similar addiction-related behaviors, such as substance use disorder or gambling disorder. As is the case with these more veteran disorders in the ICD, a diagnosis of gaming disorder can only be applied after negative behavioral patterns have persisted for at least 12 months.
“It cannot be just an episode of few hours or few days,” Poznyak said. “Millions of gamers around the world, even when it comes to the intense gaming, would never qualify as people suffering from gaming disorder,” Poznyak said, adding that the overall prevalence of this condition is “very low.”
However, he also notes that exceptions to the 12-month rule can be made if enough criteria are met and the symptoms are severe.
“And let me emphasize that this is a clinical condition, and clinical diagnosis can be made only by health professionals which are properly trained to do that,” he adds.
As far as insurance coverage goes, that’s still up to authorities — the ICD has no power over those decisions. However, by officially recognizing gaming disorder, the document paves the way for prevention and treatment options that “can help people to alleviate their suffering.” Poznyak adds that most treatments for gaming disorder are “based on the principles and methods of cognitive behavioral therapy,” and social as well as family support is very important in helping patients overcome the disorder.
Still, there is a lot we don’t yet understand about gaming disorder. While widely hailed as a good addition to the ICD, doctors also have some reservations — mostly that there is still relatively little research into this disorder. Some propose that it’s merely a coping mechanism for people struggling with anxiety or depression. We just don’t know yet.
The WHO hopes its inclusion in the ICD will stimulate debate as well as further research and international collaboration.
The World Health Organisation (WHO) has added a mysterious affliction — dubbed ‘Disease X’ — to the list of diseases they fear could start a global pandemic in the future.
Image credits: Bruno Glätsch.
Each year, the Geneva-based WHO — tasked with monitoring and safeguarding world health — convenes a high-level meeting of senior scientists, listing diseases that risk prompting a major international public health emergency. Contenders are weighed primarily on their potential to rapidly epidemics of huge proportions, even global pandemics, as well as the real-life damage they have proven capable of.
In previous years, the listing was made up of viruses that had seen outbreaks in recent years, such as Ebola, Zika, Lassa fever, or Sars (severe acute respiratory syndrome). But for the first time the WHO introduces a mysterious condition on the list, dubbed “Disease X“.
Eyes on the horizon
Despite its name, disease X is not spread around by one group of highly-gifted mutant children in both comic and film. In fact, it’s not actually ‘real’ in the strict sense of the word — Disease X is a hypothetical virus. It’s something that could emerge and then go on to cause widespread infection across the globe.
Luckily, for now, it all hinges on that ‘could’. Disease X is a placeholder: a reminder not to get complacent in our fight against would-be pathogens.
“Disease X represents the knowledge that a serious international epidemic could be caused by a pathogen currently unknown to cause human disease”, the WHO said in a statement.
The statement went on to explain that adding it to the list should help promote and guide “research and development preparedness that is relevant for an unknown Disease X as far as possible.” The mysterious nature of the disease is meant to ensure flexible planning of diagnostics tests and vaccine strategies, so that that they may be applied to a wide range of possible scenarios.
“History tells us that it is likely the next big outbreak will be something we have not seen before”, John-Arne Rottingen, chief executive of the Research Council of Norway and a scientific adviser to the WHO committee, said for The Telegraph.
“We want to see ‘plug and play’ platforms developed which will work for any, or a wide number of diseases; systems that will allow us to create countermeasures at speed.”
Disease X could spring up from a lot of different sources and infect us via innumerable vectors, Mr. Rottingen says, although zoonotic transmission (an animal virus evolving to infect humans) is the most likely. Ebola, salmonella, and HIV are believed to be zoonoses.
In modern times, humans have spread across the face of the planet, inhabiting and shaping virtually all ecosystems. This has also brought us in closer contact and closer contact with more species of animals than ever before, exponentially increasing the likelihood of zoonoses.
“It’s a natural process and it is vital that we are aware and prepare. It is probably the greatest risk,” Mr. Rotingen adds.
Given the rapid development of gene-editing technologies, Disease X could also spring up from human error or malevolence — in which case, having a flexible, widely-applicable plan of action is of paramount importance. Last week’s events showed just how far the reticence of governmental or private actors on using chemical and bio-weapons has decayed, further fanning concerns that Disease X might come from a human laboratory.
Whatever the case may be, the WHO hopes its list will spur governments across the globe to invest more into strengthening local health systems. Primary care systems (local doctors and nurses) are key to safeguarding public health, as they’re our best bet for detecting outbreaks of a new disease early on, and containing it before it spreads.
The WHO says it omitted several groups of diseases, such as hemorrhagic fevers and emergent non-polio enteroviruses from its priority list. However, it also warned that these pathogens still pose a serious risk to public health, and should be “watched carefully”. These classes will be considered for inclusion on next year’s list.
The World Health Organization issued a call for governments around the world to basically boycott tobacco giant Philip Morris International’s proposed anti-smoking foundation, citing a glaring conflict of interest.
The WHO’s flag. Image credits Flickr / United States Mission Geneva.
Earlier this month, Philip Morris International pledged US$80 million per year for the next 12 years towards the creation of the Foundation for a Smoke-Free World, a non-profit organization. This Thursday, the World Health Organization responded by calling on governments to not get involved with the foundation, and for the public to basically not trust what it says.
The WHO (UN’s public health body) sensibly decided that there’s an inescapable conflict of interest in big tobacco funding such research. Moreover, the WHO says we already have proven techniques at our disposal to tackle smoking, such as taxation, graphic warning labels, advertising bans, and creative campaigns. Measures which (coincidence?) tobacco companies have vehemently opposed in the past.
“WHO will not partner with the Foundation. Governments should not partner with the Foundation and the public health community should follow this [tried and true approach to tackling smoking],” it said.
The foundation will be headed by Derek Yach, a former senior official at the WHO has been a notable advocate for the switch to e-cigarettes that heat, rather than burn, nicotine-packed substances — a.k.a vapes. He wasn’t very happy with the WHO’s views, saying more and closer cooperation is required to fight smoking.
“I am deeply disappointed, therefore, by WHO’s complete mischaracterisation of the nature, structure and intent of the Foundation in its recent statements – and especially by its admonition to others not to work together.”
He adds that the foundation is a non-profit, with strict rules set in place to keep the tobacco industry from meddling in its internal workings, and whose research would be subjected to peer review. Although the foundation is supposedly independent, the tobacco giant is so far its only contributor.
Personally, I think the WHO made the right choice here. We’ve seen before that corporations — especially those whose product can cause a lot of damage to consumers in the long run, like alcohol, tobacco, fossil fuels, and let’s do fossil fuel again — have a history of funding shady or outright false research to promote their own ends. Peer-review isn’t always effective in sifting through the bogus papers, and even a single such work gets magnified and constantly cited when the issue finds its way in public discussions.
The timing of PMI’s commitment is also a bit suspicious. Through the first quarter of 2017, their “cigarette shipment volumes fell by 11.5% year-on-year, but its heated tobacco shipments were up almost ten-fold — overall, unit shipments were down 9.4% and net revenues were down 1.4%,” Fortune wrote earlier this month.
Funding research bodies to investigate “a better choice” in smoking, one that would help “accelerate smoker adoption of less harmful alternatives” kinda sounds more like an “hey here is some money, prove vaping is safe,” doesn’t it? Especially when it comes from a tobacco company who’s seeing a cigarette sales drop but e-cigarette sales on the rise.
PMI also said its contributions depended on the foundation’s “requirements and operations,” which sure, could mean just that — but it could also be a veiled threat to withhold future funding if the foundation doesn’t deliver.
So what do you think? Let us know in the comments.
Between reports of melting icecaps, starving polar bears and reports of food shortages, it’s easy to become pessimistic about life. But it’s not all bad, as a recently released report by the UN, published in The Lancet, shows how pregnancy-related deaths have fallen almost by half in the past 25 years.
Maternal mortality rates are down by half since 1990. Image via flikr
Around 303,000 women died of complications during pregnancy or up to six weeks after giving birth in 2015 – down from 532,000 in 1990. While only nine countries hit the target set by the UN, WHO (World Health Organization) officials consider the results indicative of “huge progress” overall, with 39 countries dramatically lowering the number of pregnancy-related deaths.
“This report will show that by the end of 2015 maternal mortality will have dropped by 44% from its levels from 1990,” said Dr Lale Say, coordinator for reproductive health and research at the WHO.
But she warned that the progress was “uneven” – with 99% of deaths happening in developing countries.
“Many countries with high maternal death rates will make little progress, or will fall behind, over the next 15 years if we don’t improve the current number of available midwives and other health workers with midwifery skills,” said Dr Babatunde Osotimehin, executive director of the UN Population Fund.
Eastern Asia saw the greatest improvement, with maternal mortality falling from approximately 95 to 27 per 100,000 live births. The UN now aims to reduce the global ratio to less than 70 per 100,000 by 2030.
A vaccine against Ebola has proven itself 100% effective in a new trial carried out during outbreaks of the disease in Guinea, and promises to bring the epidemic to an end, scientists claim.
The vaccine, after being approved for testing by WHO. Image via ibtimes.co.uk
The trials involved 4,000 participants, and the results are spectacular – the vaccine was developed and tested in an astonishingly short time. Scientists, doctors, donors and drug companies collaborated to race the vaccine through a process that usually takes more than a decade in just 12 months.
“Having seen the devastating effects of Ebola on communities and even whole countries with my own eyes, I am very encouraged by today’s news,” said Børge Brende, the foreign minister of Norway, which helped fund the trial.
“This new vaccine, if the results hold up, may be the silver bullet against Ebola, helping to bring the current outbreak to zero and to control future outbreaks of this kind. I would like to thank all partners who have contributed to achieve this sensational result, due to an extraordinary and rapid collaborative effort,” he said on Friday.
Although the outcome of many cases is yet unknown and the final tole will be a lot heavier, a total of 27,748 recorded cases in Guinea, Liberia and Sierra Leone up to 26 July and 11,279 reported deaths make the outbreak in Africa the most devastating flare-up of the Ebola virus we have ever witnessed. In the week ending 26 July, there were just four new cases in Guinea and three in Sierra Leone.
A lot of work has been put into developing fast, reliable methods of identifying patients infected with the virus, but up to now, there was no reliable vaccine. So how did they do it?
Put a ring on it!
Because the number of cases in West Africa is diminishing, and due to the shifting nature of the epidemic, with small but sudden outbreaks all over the region, researchers used a novel method of testing out the vaccine.
The “gold standard” for vaccine testing is to administer it to 50% of the population, while giving the remaining half a placebo. Instead of this, a “ring” method was preferred, similar to that which helped prove the smallpox vaccine worked in the 1970s.
When Ebola erupted in a village, researchers administered the vaccine to the (willing) relatives, neighbours, friends and people who came in contact with the sick, and those that came in contact with this first “ring” of people, in an attempt to contain the virus. Children, adolescents and pregnant women were exempt from the vaccination as there was no safety data for them. In practice, an average of 50% of people in these clusters were administered the treatment.
The Ebola virus. Image via telegraph.co.uk
To test how well the vaccine protected people, the clusters were randomly assigned either to receive the vaccine immediately or three weeks after Ebola was confirmed. Among the 2,014 people vaccinated immediately, there were no cases of Ebola from 10 days after vaccination – allowing time for immunity to develop – according to the results published online in the Lancet medical journal (pdf). In the clusters with delayed vaccination, there were 16 cases out of 2,380.
WHO made it happen
The trial was sponsored by the World Health Organisation, as “nobody wanted to step into this role so we took the risk”, said assistant director-general, Dr Marie-Paule Kieny.
Funding came from the Wellcome Trust and other partners, including the governments of Norway and Canada.The British government contributed £1m of the trial funding and has said it will increase that amount to help allow the testing to continue.
Others involved included Médecins sans Frontières, whose volunteer doctors were on the front line, and the London School of Hygiene and Tropical Medicine. About 90% of the trial staff were from Guinea, a country where no clinical research had been carried out before. The vaccine is made by Merck.
“We believe that the world is on the verge of an efficacious Ebola vaccine” said Kieny.
In terms of vaccine trials, the number of people it was trialed on is small but very promising, said Kieny. She expects that the success rate once more people are treated with the vaccine will stabilize somewhere around 75-100%.
The authors of the research believe the ring design made it “logistically feasible” to conduct trials even in poor countries in the middle of a fading epidemic and it was a promising strategy for the future.
“This trial dared to use a highly innovative and pragmatic design, which allowed the team in Guinea to assess this vaccine in the middle of an epidemic,” said Jeremy Farrar, director of the Wellcome Trust and one of the world’s leading experts on infectious disease. “It is a remarkable result which shows the power of equitable international partnerships and flexibility.
“Our hope is that this vaccine will now help bring this epidemic to an end and be available for the inevitable future Ebola epidemics. This partnership also shows that such critical work is possible in the midst of a terrible epidemic. It should change how the world responds to such emerging infectious disease threats.”
John-Arne Røttingen, the head of infectious disease control at the Norwegian Institute of Public Health and chair of the trial’s steering group, said it had been a race against time in the most challenging circumstances.
“We are really pleased with the interim results,” he said. “It is really important to add the vaccine to the traditional hygiene measures we have used in the response so far. I believe this will be an important contribution to getting down to zero cases.”
Médecins sans Frontières said it was keen for the vaccine to be used in Sierra Leone and Liberia, where there were still cases.
“With such high efficacy, all affected countries should immediately start and multiply ring vaccinations to break chains of transmission and vaccinate all front-line workers to protect them.”
The trial will continue without randomization. What that means is that in Guinea, where there have been 3,786 cases and 2,520 confirmed deaths, every person that comes in contact with or that develops Ebola, and their secondary ring, will be offered the vaccine. Work performed in Gabon has also shown that the vaccine is safe for children and adolescents, so it will be offered to them too.