💉Mpox becomes stronger, brace for impact; Malaria comes for the world, vaccines be damned; The world gets hungrier

#514 | MSF says clinical trials cost way less than industry makes it out to be; Hep A surges in Colombia; Birds fly everywhere

Apr 26, 2024

Hello, and welcome back to The Kable one last time this month. And hold on to your seats because we're taking you on quite the ride this week.

We begin with news that Benin, Liberia and Sierra Leone have also launched malaria vaccination programs, bringing the count of countries (hehe) immunising against malaria to 8.

And Gavi has an excellent read on Angola bracing for an imminent clash with cholera.

Over in Ethiopia, Phase 2 trials are underway for an oral drug against visceral leishmaniasis. Yay!

Across the Atlantic, officials in Medellin, Colombia, are on high alert because Hepatitis A cases in the city have shot up by 230%.

And all those cough syrup recalls issued across Africa last week? The WHO now says that particular batch is no longer available on the continent.

We've all heard stories about contaminants in drugs made in the pharmacy of the world. However, food regulators in Hong Kong and Singapore have now found ‘cancer-causing’ ingredients in spice powders made in India too.

Apropos of nothing, India's Dr Reddy's is recalling six lots of a drug used in the US to reduce blood phenylalanine levels due to 'subpotency'.

The Covid patent wars are far from over. First, Pfizer and BioNTech took Moderna to court in the UK. Then GSK said Pfizer and BioNTech have infringed on its mRNA patents. Now, all we need is for Moderna to sue GSK so the circle can be complete. Amidst all this slinging and counter-slinging, Acuitas and Curevac have found a way to settle their lawsuit on the same subject.

Speaking of Covid, what a pandemic it ~~was~~is, eh? Are you ready for the next pandemic already? Because scientists say it is coming. And it will be caused by the flu. Read on to see if there may be other contenders in the mix.

And right on cue, CEPI is organising a global to-do to "bolster pandemic preparedness."

Elsewhere, the WHO Global Malaria Programme has released a new operational strategy outlining key priorities and activities until 2030 to address the global malaria burden. The strategy focuses on four strategic objectives, including developing norms and standards, introducing new tools and innovation, promoting strategic information for impact, and providing technical leadership in the global malaria response.

And finally, everybody's favourite poison may soon go extinct. No, not that one. It's chocolate we're talking about. Because a rapidly spreading virus - the cacao swollen shoot virus disease (CSSVD), real name, no gimmicks - is attacking cacao trees in Ghana, resulting in harvest losses of between 15 and 50%. Today, Ghana, tomorrow, the world.

Stories Of The Week

A for apple, B for bird flu. How likely do you think a bird flu pandemic is? Let's start with the bare facts. It's no longer birds alone that are spreading this flu. In the US, the US Department of Agriculture said that cow-to-cow transmission is a factor in the spread of bird flu in dairy herds, even if it does not know quite how the virus is being spread. They even found remnants of bird flu in pasteurised milk, although the US FDA says it is still safe to consume. For now. Elsewhere, other researchers posit that bird flu in supermarket milk in the US might be more widespread than believed, and genetic analysis appears to indicate that bird flu jumped to cows in the US in 2023 itself. We won't be surprised if this were true. Minks and sea lions have been succumbing to this all year long last year. Even WHO scientists are reported to have said that the risk of bird flu jumping to humans is a matter of concern. Since bird flu outbreaks started being reported regularly in late 2022, India hadn't reported any cases. But that no longer holds true, with a poultry farm in Jharkhand having to cull 2,000 birds. Over in Europe, regulators have recommended vaccinating poultry with a new vaccine that is effective against the currently circulating strain of bird flu. Here is a list of all the bird species known to be affected by bird flu. What is that? Vaccines for humans? The US says it can vaccinate 1 in 5 of its population if it comes down to that.
(USDA, US FDA, Stat, The Guardian, India TV, EMA, FAO, Barrons)

A for apple, M for mpox. Bird flu doesn't scare you much? How about mpox, then? Remember we said they found a new clade of the disease in the Democratic Republic of Congo (DRC) last week? Now, the neighbouring Republic of the Congo has declared a mpox epidemic. The first mpox case in the country was reported last month. Data suggests that this new strain has gained the ability to transmit sexually, which makes it that much more dangerous. So, make like a priest and celibate, we guess.
(Reuters, AP News, Nature)

Oh wait, M is for malaria. And it is still killing people in Kenya. Malaria continues to pose a significant public health challenge in the country, where the disease predominantly affects children under five and pregnant women, contributing to substantial morbidity and mortality. In 2022, Kenya reported approximately 5 million malaria cases and over 12,000 deaths, with the highest impact in the hot and humid coastal regions and the wet areas near Lake Victoria. Despite the introduction of the world's first malaria vaccine in pilot regions showing promising results, the widespread availability of this vaccine still remains uncertain (look at our Long Reads section for more on that topic.) Traditional control methods such as insecticide-treated bed nets and environmental spraying are still in use, but their effectiveness has plateaued, necessitating innovative approaches. As in other parts of Africa, in Kenya too, financial constraints further complicate the situation, with a reported funding shortfall of nearly $52 million. The future is local, though. Efforts to enhance local pharmaceutical capabilities, such as the WHO-approved Kenyan production of the antimalarial drug Spaq, represent a critical step towards reducing dependency on imported drugs and strengthening regional health resilience.

Kenya might do well to borrow a page or two from Rwanda on how to counter this mosquito menace. Devex reports on Rwanda's main entomology laboratory in Kigali, which is at the forefront of combating malaria. The lab meticulously analyses every part of collected mosquitoes to track malaria transmission and assess the efficacy of current interventions. This is vital in determining the adaptation and resistance patterns of malaria vectors and parasites, particularly with the increasing challenges posed by climate change and insecticide resistance. The lab's work extends beyond analysis; it plays a crucial role in informing and adjusting national malaria control strategies. Despite challenges such as funding dependencies and the looming threat of artemisinin resistance, the lab's efforts have contributed to a significant drop in malaria cases and a strategic response to potential outbreaks triggered by environmental changes.

Malaria is no longer a Global South problem, though. Historically eradicated in many parts of the US and Europe, malaria is showing signs of potential resurgence, thanks to climate change, which extends the breeding season for mosquitoes and accelerates the life cycle of malaria parasites. Recent cases of locally acquired malaria in the US and other regions long declared malaria-free underscore this threat. Increased global mobility and climate-induced environmental crises, such as flooding and extreme temperatures, also elevate the risk of malaria outbreaks by disrupting ecosystems and human settlements, creating ideal breeding conditions for mosquitoes. The WHO's latest report highlights the impact of climate change on malaria, particularly in vulnerable regions where the disruption of healthcare services exacerbates the situation.
(AP News, Devex, Gavi)

A for Africa. The Africa CDC has launched two significant projects, the Integrated Genomic Surveillance and Data Sharing Platform (IGS) and Integrated Genomic Surveillance for Outbreak Detection (DETECT), in collaboration with the European Union. These initiatives are integral to the enhanced Africa Pathogen Genomics Initiative (Africa PGI 2.0) and aim to bolster the capabilities of African nations in molecular outbreak detection, antimicrobial resistance (AMR) genomic surveillance, and efficient data sharing.
(Africa CDC)

A for apple, H for hunger. A new report by the FAO - The Global Report on Food Crises - highlights a dire escalation in global hunger, with 282 million individuals across 59 regions grappling with acute hunger in 2023, marking an increase of 24 million from the previous year. This surge is partly attributed to expanded coverage of affected areas and worsening conditions, particularly in the Gaza Strip and Sudan. Persistent over the last four years, the crisis sees nearly 22% of evaluated populations in acute food insecurity, with children and women disproportionately affected. Over 36 million children under five suffer from acute malnutrition, exacerbated by displacement due to conflicts and disasters.
(FAO)

A for antibiotics. The WHO has highlighted a significant issue of antibiotic overuse during the COVID-19 pandemic, which has likely fuelled the "silent" spread of antimicrobial resistance (AMR). Despite only 8% of hospitalised Covid patients having bacterial co-infections that required antibiotics, approximately 75% were administered antibiotics preemptively. This misuse was most pronounced in the Eastern Mediterranean and African regions, with high prescription rates even among patients with mild or moderate symptoms. The majority of the antibiotics used globally were from the 'Watch' category, which poses a higher risk of developing resistance. The findings, gathered from around 450,000 patients across 65 countries from 2020 to 2023, underscore the urgent need for more rational antibiotic prescribing practices to avert unnecessary risks to patients and the wider population.
(WHO)

A for apple, B for Blow to Big Pharma. Doctors Without Borders/Médecins Sans Frontières (MSF) has made a pioneering move by publicly revealing the costs of its TB PRACTECAL clinical trial, amounting to approximately $36 million. This marks the first instance of such detailed clinical trial cost data being made openly available, challenging the prevailing opaque practices in drug development and the narrative that high drug prices are necessary to cover substantial R&D costs. MSF aims to set a precedent for transparency that could reshape access to medical tools globally. This initiative includes the development of the "Transparency CORE" toolkit, designed to encourage other organisations to disclose their clinical trial costs. This transparency is crucial, as it could influence pricing policies and negotiations, potentially making lifesaving drugs more accessible. This approach is also supported by evidence indicating that high R&D spending does not correlate with high drug prices, challenging the industry's justification for high costs and pushing for more equitable access to medical advancements.
(DWB/MSF)

Agency Observer

A stitch in time saves nine. A groundbreaking study soon to be published by The Lancet, in collaboration with the WHO, illuminates the profound impact of global immunisation efforts over the past fifty years, marking the upcoming 50th anniversary of the Expanded Programme on Immunization (EPI). This comprehensive analysis credits vaccines with saving approximately 154 million lives, predominantly infants, translating to 6 lives every minute each year. Vaccines have significantly reduced infant mortality, particularly measles vaccinations, which are responsible for 60% of the lives saved. Over the decades, immunisation has expanded beyond children to include adolescents and adults, targeting 14 major diseases and increasing global infant immunisation coverage from under 5% to 84%. This study not only highlights the historical success of vaccines in preventing and potentially eradicating diseases like polio and smallpox but also underscores the critical ongoing need to sustain and expand these efforts to meet future health challenges globally.
(WHO)

Bottom line

Feeling hot, hot, hot. The International Labour Organization (ILO), in a new report, highlighted the severe impact of climate change on global workforce health, revealing that around 70% of workers worldwide face climate-related health risks. The alarming data includes almost 19,000 annual deaths and over 2 million disability-adjusted life years lost due to occupational injuries from extreme heat. Added to that, UV radiation, workplace air pollution, and exposure to pesticides and vector-borne diseases contribute significantly to worker mortality, with thousands of deaths annually attributed to these factors. As record-breaking temperatures are anticipated in 2024, surpassing previous highs, the report underscores the urgency for comprehensive global protection standards, with current standards inadequate in mitigating the escalating risks of climate change on worker health.
(ILO)

Asia #1 in climate impact. Asia is the region most severely impacted by climate-related disasters in 2023, according to the World Meteorological Organization's (WMO) new State of the Climate in Asia 2023 report. The report disclosed a staggering 79 hydro-meteorological disasters, predominantly floods and storms, which collectively claimed over 2,000 lives. Notably, Asia recorded unprecedented high temperatures, which accelerated from western Siberia to Japan, significantly above the global average warming rate. This rise in temperature contributed to a pronounced loss of glacier mass in Asia's high-mountain areas, further exacerbated by record-breaking temperatures and prolonged dry spells. The WMO attributed the increased frequency and intensity of these extreme weather events to climate change, marking a dire year for the region amidst ongoing environmental challenges.
(WMO)

Long reads

New vaccines, same old challenges. The ongoing struggle against malaria in Africa, underscored by the emergence of new vaccines, highlights significant gaps in global health responses. Despite the potential to dramatically reduce malaria fatalities with these vaccines, the rollout has been sluggish and inadequately explained by global health organisations. The disparity between the potential production of vaccines and the doses actually planned for distribution raises critical questions about the commitment of international institutions to combat a disease that disproportionately affects Africa. The situation is further complicated by logistical, regulatory, and financial challenges that hinder vaccine distribution to the most affected regions. This pieceby Devex offers an insightful analysis that delves into the front-line and behind-the-scenes efforts to address malaria in Africa.
(Devex)

Eat poop and die, die, die. Researchers in Uganda's Budongo Forest Reserve observed chimpanzees consuming dry bat faeces, a behaviour never recorded in 60 years of study. This peculiar dietary choice led to the discovery of numerous unknown viruses, including a new coronavirus, detailed in a Communications Biology study by the researchers. Their study highlights a largely unexplored method of virus transmission from bats to other mammals, raising significant concerns about potential new pathways for zoonotic diseases to infect humans. This discovery also underscores the intricate and often perilous interconnections within ecosystems, especially as human activities continue to reshape wildlife habitats. For a deeper understanding of these critical findings and their implications, take a gander at the article over on Science first and then the study itself.
(Science)

Oh, and Gopal Nair doesn't want you to see this.