Posts or Comments 06 July 2022

Monthly Archive for "April 2022"



Development &poverty &Vaccine Bill Brieger | 28 Apr 2022

African Immunization Week Press Briefing: Reducing Poverty, Saving Lives

The World Health Organization’s African Regional Office held a press briefing to mark World Immunization Week/African Immunization Week. Three experts shared their observations of developments and trends and responded to questions over the course of an hour on Thursday 28th April. The panelists included Dr Benido Impouma, Director, Communicable and Noncommunicable Diseases, WHO Regional Office for Africa, Professor Helen Rees, Executive Director, Wits Reproductive Health and HIV Institute, University of Witwatersrand, South Africa, and Hon. Dr Kailash Jagutpal, Minister of Health and Wellness, Government of Mauritius. In addition, Dr. Mory Keita answered questions about the latest Ebola Virus Disease (EVD) in the Democratic Republic of the Congo (DRC).

Concerns about COVID-19 featured in this immunization briefing for several reasons. First was the low coverage of COVID vaccines on the continent. Second was the way that COVID put demands on health workers’ time as well as on precautions to be undertaken, which limited the reach and coverage of immunization services for other vaccine preventable diseases (VPDs). Also, the resulting reduction in immunization coverage was responsible for other deadly outbreaks, notably measles. Between January and March 2022, for example, there was a 400% increase in measles cases compared to the same period last year.

Dr. Impouma that COVID ‘taught the lesson’ that catch-up campaigns for VPDs were not only necessary but could be handled successfully. Finally, health services learned the importance of integration, whether joining COVID and Yellow Fever vaccination efforts in Ghana or integrating COVID with maternal and child services and immunizations. Ultimately, health workers learned that by strengthening ‘routine’ immunization, health systems overall could be strengthened thus, making progress on achieving Health For all through Universal Health Coverage.

Dr. Jagutpal shared key considerations for successful life-course immunization programs. Mauritius offers free, universal vaccination from birth. Thirty VPDs are addressed ranging from Human Papilloma Virus to flu and not of course, COVID-19. Success is based on involvement of all stakeholders through regular meetings where real time decisions can be made. Mauritius in one of the first to formalize the COVID Vaccine Pass Card and has achieved 60% full vaccine coverage including booster shots.

Prof Rees noted that the term ‘routine services’ makes vaccines seem boring and less important, when in fact, they should be seen as “Core Services”. This central role of vaccines goes beyond preventing specific diseases. By saving children’s lives and reducing the time demands on parents who care for children suffering VPDs, immunization promotes human development, reduces poverty, enhances the economy, and strengthens employment. There remain children who have had no vaccines. Identifying these ‘zero dose’ children and the communities in which they cluster can help us focus on ameliorating the vulnerabilities of their families and bring multi-sectoral resources to bear on strengthening poor communities.

Dr Keita reviewed the two recent cases, now deaths from Ebola in Équateur Province in DRC, its third EVD outbreak. Ebola vaccine teams have started working, reaching 78 contacts. He lamented that much of the DRC has a natural ecological predisposition for the animal reservoirs of Ebola, so more effort on making regular vaccines and treatment available is required. As Prof Rees pointed out, this setting is a perfect example of the need for a One Health approach to many of our health challenges which are zoonotic in nature. Even with coronaviruses, animal reservoirs are a central element of transmission.

Additional research is recommended in several areas. The slowly increasing laboratory capacity in Africa was mentioned. It contributed to finding Omicron and its variants. Potential new ones may have been identified recently. Seropositivity analysis has found that 80-90% of people tested may already have COVID antibodies. Research can clarify the role of vaccines in these circumstances. Research as well as regular program monitoring is still needed to determine the factors that may cause children to miss vaccines. It is often not the case that parents are ‘hesitant’, but that system and community factors combine to prevent them from seeking care. Research can also assist in finding vaccines and tools for tackling other deadly pathogens such as Lassa Fever.

Vaccines save lives from endemic diseases, but in the long-term vaccinated families and communities can fight poverty which itself is a leading factor in illness and death. This will accomplish the theme of this year’s observance, “Long Life for All.

Advocacy &Vaccine Bill Brieger | 25 Apr 2022

World Immunization Week Starts with World Malaria Day

One might think initially that the convergence of World Malaria Day and World Immunization Week would simply be a coincidence. This year there is a major connection since WHO has approved the first ever RTS,S/AS01 malaria vaccine which has undergone decades to clinical testing and most recently, a successful 3-year pilot intervention in Malawi, Kenya, and Ghana.

During her keynote address at the Johns Hopkins Malaria Institute’s World Malaria Day Webinar today, The WHO Regional Director for the African Region, Dr. Matshidiso Moeti, stressed the importance of integrated disease control efforts drawing on the region’s efforts to tackle neglected tropical diseases, COVID-19 and of course, malaria. She highlighted the importance of surveillance, and in That context pointed out a serious fact. The population of sub-Saharan Africa had doubled since the start of the Roll Back Malaria initiative, meaning that to achieve the same level of coverage of key interventions, one needs to reach many more people, whether for malaria control or child immunization.

Thus, increasing targets and goals affect both immunization and malaria programs, as well as efforts to roll out the malaria vaccine. At present there is only one producer of the vaccine, GlaxoSmithKline, and while that company is working with another company in India to produce RTS,S in the global south, GSK is maintaining control of the AS01 adjuvant. Production targets have so far been geared to meeting the needs in the pilot districts of the three intervention countries, and for the foreseeable future this will address less than 10% of need in P. falciparum endemic areas, especially in Africa.

WHO and partners including UNICEF and GAVI are in the process of figuring out equitable ways to distribute what is available now and encouraging the ramp up of vaccine production. The need to vaccine technology transfer to Africa is also being considered. Additionally, eyes are focused on new malaria vaccine candidates which might come on board in about five years.

The current malaria vaccine, while reducing severe disease, does not have the highest efficacy, and experts caution that is is therefore, not a silver bullet. They do explain that the vaccine is an important addition to the malaria toolkit, and should be a central part of integrated malaria control planning. At present though, we are not only running in place to meet the needs of an ever increasing number of children at risk, and we also must cope in an ethical and efficient way with limited supplies of the vaccine for the near future. This is the double challenge to start Malaria Day and Vaccine Week.

 

 

Environment &Mosquitoes Bill Brieger | 22 Apr 2022

What do mosquitoes think of Earth Day?

On Earth Day (and hopefully throughout the year) we contemplate what humans have done to ecosystems and climate. Should mosquitoes actually think about us at all, they might be grateful for the changes that increase their breeding sites.

Deforestation and modern agricultural practices favor the Anopheles group. Expanding urbanization makes life easier for the Aedes family.

Overall warming may open up new parts of the world for mosquitoes, though hotter and drier areas left behind make mosquito propagation more difficult. These highly mobile creatures may have few complaints for now, though proposed efforts to disperse particles in the atmosphere for cooling effect and current efforts to release sterile male mosquitoes into the environment might worry people as well as mosquitoes.

Human activity has modified the environment, and mosquitoes have taken advantage where they can. Environmental efforts to beat back mosquitoes need to be thought through very carefully to avoid more unintended consequences.

 

Agriculture &Children &Climate &Coordination &Development &Elimination &Environment &Epidemiology &Food Security Bill Brieger | 15 Apr 2022

Malaria elimination challenges around the world

In the past week, news has featured challenges to malaria elimination around the globe. Starting in Papua New Guinea which accounted for accounted for 86% of all cases in the Western Pacific Region in 2020. While there are 39% fewer cases in the region since 2000, there was an increase of 300,000 cases between 2019 and 2020. It is mainly in the six countries of the Greater Mekong subregion where progress has been steady.

Moving east to the Brazilian Amazon, one finds wildcat gold mining operations are not only destroying Native American ecosystems but are carving huge holes in the earth which are perfect breeding conditions for mosquitoes. This means that malaria cases among the Yanomami indigenous people living in the Brazilian Amazon have increased by more than 12 times since 2014.

Also within South America, one finds that although Paraguay was certified by the World Health Organization (WHO) as free of local transmission of malaria in 2018, experts are warning that travelers entering the country from areas with malaria transmission could easily reintroduce the disease. Hence vigilance is urged.

Crossing next to sub-Saharan Africa, one reads of studies showing an increasing link between malaria and agriculture across the region. As population expands in the region, more food, water and agricultural commodities are required. Irrigation and deforestation to clear land for agriculture increase the risk of childhood malaria in sub-Saharan Africa. The experts recommend that African ministries of agriculture, health, and environment need to collaborate on safer development policies and practices, not only to curb malaria, but the devastating effects of climate change.

Finally continuing back to Asia, one finds what might be termed an epidemiological conflict between Nepal, which is nearing malaria elimination for 2025, and its southern neighbor India, which is a source of imported malaria. Although the number of indigenous cases is nearing zero, health authorities fear that imported cases of of malaria from India are so high that local transmission could be reignited.

Malaria is clearly a global health problem. Collaboration and coordination across continents is needed to eliminate the scourge.