💊 Africa’s AMR burden; No cold FDC for kids, says India’s CDSCO; Air con is the answer
#498 | Brushing away pneumonia; SCANning away diabetes; Digging away from detection
Hello, and welcome back to The Kable for the last Thursday this year, which we're kicking off with momentous news. The first-approved malaria vaccine has landed on the shores of Sierra Leone.
In a huge leap forward for local manufacturing in Africa, Nigeria-based Innovative Biotech has acquired advanced diagnostic technology from the NIH, enhancing its capability to manufacture diagnostic tests in Africa, a significant move since 99% of such tests are currently imported. This technology, complemented by a new vaccine manufacturing facility, aligns with the African Union's goals and promises to revolutionise disease diagnosis and treatment on the continent, particularly for endemic and neglected tropical diseases.
Elsewhere in Nigeria, the country's first locally manufactured glucose meter facility, Colexa Biosensor Diagnostics Manufacturing, was unveiled, marking another significant step in local health technology and addressing the rising burden of non-communicable diseases like diabetes. This initiative, which aligns with the government's focus on reducing healthcare costs and promoting local manufacturing, has the potential to meet and exceed domestic needs, opening avenues for export, job creation, and economic growth, while providing an essential tool for the 3.6 million Nigerians living with diabetes.
If it is diagnostic tests in one African country, it is impetus for medical tourism in another. The Africa Medical Tourism Council (AMTC)Â has been launched in Accra, Ghana, aiming to develop a structured medical tourism infrastructure and enhance skills and equipment in medical specialties, thereby boosting the nation's healthcare services and reputation in medical excellence. This initiative, expected to attract more medical tourists and reduce outbound healthcare travel, aligns with global trends in medical tourism and emphasises the importance of high standards in healthcare delivery to position Ghana as a premier medical tourism destination in Africa.
In continuing good news for localisation in Africa, the EU has pledged an additional €32 million to support Ghana in developing its domestic vaccine production capabilities, as part of the 'special measure' initiative under the Team Europe initiative on manufacturing and access to vaccines, medicines, and health technologies in Africa (MAV+). This initiative, backed by €1 billion from the EU and European development finance institutions, aims to enhance the skilled workforce, facilitate technology transfer, and strengthen the regulatory environment in Ghana, reflecting the EU's commitment to collaborating with African countries in improving local vaccine manufacturing and healthcare infrastructure.
That's not all the EU is up to today. It has also invested over €900 million in Rwanda, primarily in health, critical raw materials, and agro-food industry development, as part of the Global Gateway strategy. This investment aims to enhance digital, energy, and transport sectors, improve health, education, and research systems globally, and includes significant funding for Rwanda's pharmaceutical sector, agricultural competitiveness, and the development of value chains for critical raw materials, reflecting a commitment to high environmental and social standards, technology sharing, and local job creation.
The Egyptian Drug Authority (EDA)Â has signed an MoU with Nigeria's NAFDAC to facilitate the entry of Egyptian pharmaceutical products into the Nigerian market, as part of its broader strategy to collaborate with African nations in the pharmaceutical sector and expand its presence in African markets.
In Bangladesh's ongoing dengue outbreak, the death toll has inched up to just shy of 1,700.
In Japan, the country's Health, Labor and Welfare Ministry plans to restrict sales of certain OTC medicines, particularly to those under 20, in an effort to combat the increasing issue of drug overdoses among young people.
GSK is expanding its focus on ADCs for cancer treatment, with a new agreement to pay $185 million to Hansoh Pharma for an experimental drug showing promise in various cancers, and potential additional fees of up to $1.5 billion based on milestones.
Intas Pharmaceuticals has secured an exclusive licensing agreement with mAbxience for a biosimilar of Etanercept, a TNF-blocking protein used in autoimmune diseases, granting Intas rights to commercialize it in over 150 countries, including Europe and the USA, with mAbxience handling development, manufacturing, and supply.
And finally, the dire situation in Gaza, where displaced children are receiving only 1.5 to 2 litres of water daily, exacerbating what was an already grave humanitarian crisis. UNICEF says there isn't even "a drop of safe water to drink in Gaza".
Newsworthy
Africa’s AMR burden. With high death counts, both HIV/AIDS and malaria are big public health concerns in Africa. But a new crisis has emerged to claim the top spot. Marking a pivotal shift in Africa’s health challenges, antimicrobial resistance (AMR) is now linked to more deaths than AIDS and malaria in the region. While the prevalence of resistance is relatively low in the WHO African region, it has the highest burden of AMR mortality – Africa’s high burden of infection-related mortality is to blame. Here, over 1.05 million deaths were associated with AMR in 2019; 250,000 deaths were directly attributable to it. Four pathogens — Streptococcus pneumoniae, Klebsiella pneumoniae, Escherichia coli, and Staphylococcus aureus — were the main culprits; each was responsible for over 100,000 AMR deaths in the region. Further, neonates in Central and Western Africa experienced a disproportionate burden.
The study highlights the need for renewed investments in vaccine development and distribution and improving access to primary healthcare and effective antibiotics. It acknowledges the challenges of surveillance, especially in low-resource settings with limited lab infrastructure; consequently, it calls for strengthened lab capacity and improved data collection efforts.
(The Lancet Global Health)
No cold cocktail for kids. Amidst concerns about the promotion of an unapproved anti-cold formulation for infants, India’s drugs regulator, the Central Drugs Standard Control Organisation (CDSCO), is banning a popular anti-cold cocktail medicine in children below four years of age. This decision comes after a recommendation on 6 June 2023 from a Subject Expert Committee (SEC). As issued in a letter by the Drugs Controller General (India) on 18 December (made public yesterday), all manufacturers of the fixed-dose combination (FDC) of chlorpheniramine maleate IP 2mg (an antiallergic drug) with phenylephrine HCL IP 5 mg per ml drops (a decongestant) are mandated to mention an appropriate warning on the label and package insert. Companies like GSK, Alembic, Glenmark, and Ipca are among those affected.
(CDSCO)
R&D
Viral locomotion. The Ebola virus is like a mole – it creates and uses tunnels to get about from one place to another. Particularly, it generates what scientists call tunnelling nanotubes to travel from cell to cell in our bodies; these dynamic connections allow for cellular communication over long distances, as far as 200 microns. These intercellular tunnels make for great hiding spots for the Ebola virus, helping it evade treatments as it moves sneakily and replicates. Tunnelling nanotubes have already been found to play a major role in promoting neurodegenerative diseases, cancer, HIV-1, and the flu, but this is the first time such a study has been conducted for Ebola. The researchers still don’t know precisely how Ebola virus particles are transported through these nanotubes, but they hope that laser microdissection, mass spectrometry, and low-abundance RNA sequencing will help them find the answer.
(The Journal of Infectious Diseases)
Say NO to diabetes! Type 2 diabetes develops in people when insulin stops giving its hundred per cent to maintaining stable blood sugar levels. But why does insulin do this? Depression? Burnout? An existential crisis? We thought we’d never know. But now researchers at Case Western University have found an answer.
Nitric oxide (NO) is produced in almost all cell types, with a crucial role in the workings of the nervous system, immune system, and blood vessel dilation. Dysfunctional S-nitrosylation (the process that turns NO into a cellular messenger) has already been linked to conditions like MS, asthma, Parkinson’s, and sickle cell disease. The authors of the study in question found that a novel enzyme SCAN (SNO-CoA-assisted nitrosylase) plays a role in S-nitrosylation, helping NO attach to target proteins like the receptors on insulin. Mice and (hu)men with insulin resistance exhibited heightened SCAN activity. Inhibiting SCAN in mouse models of diabetes eliminated symptoms of the condition. So it seems that type 2 diabetes may be driven by an overabundance of NO attaching to insulin. Here’s hoping for new treatments for not only type 2 diabetes but also other diseases caused by enzymes causing the over-attachment of NO to proteins!
(Cell)
The Kibble
Brush your teeth, prevent lung defeat. Wanna protect your lungs from hospital-acquired infections? You don’t need no fancy devices or drugs. What you need is some regular brushing for those pearly whites! Researchers at Brigham and Women’s Hospital have found that hospital-acquired pneumonia rates, ICU mortality, duration of ICU stay, and time spent on mechanical ventilation were lower among patients who received daily toothbrushing compared to those who did not. Go on then, say buh-bye to that oral bacteria – it’s a whole lot cheaper than spending more time in the hospital.
(JAMA Internal Medicine)
Bottom line
Air con ftw! Extreme heat is linked with higher mortality, but surprisingly, in Spain, increases in annual mean temperatures have been accompanied by lower heat-associated mortality. Extreme cold, too, seems to have lost its tight hold on our lives. The secret behind these miracles? Why, air conditioning and heating systems, of course.
Research from the Barcelona Institute for Global Health (ISGlobal) has found that air conditioning (AC) and heating systems have considerably reduced mortality linked to extreme highs and lows of temperature in Spain. AC reduced heat-related mortality by a third, while heating reduced extreme cold-linked deaths by half. This led the researchers to conclude that these reductions in mortality are consequences of socioeconomic development rather than other interventions like heat-wave warning systems. Unfortunately, AC is still unaffordable for many households in Spain – the situation is likely worse in LMICs. Also, lest we forget, the widespread use of AC could make global warming even worse. Nonetheless, these findings are important for the development of future adaptation strategies.
(Environment International)
Africa’s climate-health crisis. Recent health crises in Africa – the expansion of malaria and Marburg outbreaks to new areas, the post-hurricane cholera outbreak in Mozambique, and a climate-associated scabies outbreak in Malawi – have shed light on the growing impact of climate change on health in the region. The African Union Climate Change and Resilient Development Strategy and Action Plan (2022-2032) has revealed that the death rate from climate change is 60-80% higher in Africa than in the next most vulnerable region i.e. Southeast Asia. With malaria and diarrhoea deaths claiming the lion’s share, by 2030, there will be up to 70,000 additional deaths in Africa due to climate change. Pre-existing vulnerabilities and the continent’s weakened ability for climate adaptation are major causes of this disparity. The lead advisor on outbreaks and epidemics at Africa Risk Capacity recommends a comprehensive approach to policymakers and climate-health experts to deal with this growing threat. The approach would ideally encompass strategic risk assessment and scenario modelling, greenhouse gas emissions reduction and adaptive health care strategies, collaboration between health care professionals and policymakers, global unity, and swift and decisive action.
(Devex)Â
Oh, and Gopal Nair doesn't want you to see this.