💉 Rwanda says hello to Marburg, Africa says mpox may be under-reported, Gilead to license Lenacapavir
#537 | Plants come for TB; Climate change helps TB; Herd immunity? What herd immunity?
Hello, and welcome back to The Kable for the first time this month. And as befits a new month, we have a new disease to grab your attention this week.
But first, some agency news. In what was quite a busy week for it anyway, the WHO also found time to up the fight against respiratory synctial virus (RSV), recommending the RSV vaccine for pregnant women and an antibody for infants. The WHO, ever fond of launching plans, also launched another plan this week, this one to combat dengue and other Aedes-borne arboviruses. And Gavi released its progress report for 2023, saying Gavi vaccinations prevented 1.3 million deaths. Significantly, Gavi's report also highlighted that co-financing crossed $200 million for the first time.
Next up in today's very short Synopsis is news from Kerala, India where four more cases of brain-eating amoeba have been detected.
And finally, in what should be good news, Gilead seems to have listened to all the voices calling for increased access to the new HIV wonder-drug Lenacapavir. In a news release this week, Gilead announced that it is inking a licensing deal with 6 generics makers to expand access to the drug in 120 low- and middle-income countries, especially those with high HIV incidence. The chosen partners are Dr. Reddy’s Laboratories, Emcure, Eva Pharma, Ferozsons Laboratories, Hetero and Mylan. However, Gilead's deal effectively excludes a large number of upper-middle-income countries that account for 41% of new HIV infections and 37% of all people living with HIV. Gilead had also been asked to allow generic production of Lenacapavir through the Medicines Patent Pool but the company is still mum on that. Well, them's the breaks, we guess.
Stories Of The Week
A new outbreak. When we began the week, we originally had this story planned for the synopsis above. However, there have been so many updates during the course of the week that it merits a place here. We're talking about Rwanda's first-ever Marburg virus outbreak. An outbreak that was only first reported over last weekend and is already the third-largest Marburg virus outbreak ever. The latest available update from the Rwanda Ministry of Health puts the number of cases at 37, with 11 deaths. Of these 37 cases, 30 are in frontline healthcare workers. The response to the outbreak in Rwanda has been quick, with more than 1,000 tests being conducted in the week. However, there is still a lack of clarity over the circumstances of the outbreak itself. WHO data indicates that the index case in the present outbreak actually died in early September, which would mean the outbreak began much earlier than reported. Other sources report that the first affected patients also had a malaria co-infection, which delayed diagnosis. Rwanda is planning trials for a vaccine shortly, and Gilead has promised to deliver 5,000 doses of remdesivir for emergency use. Some good news: Germany had reported two suspected cases of Marburg virus in travellers from Rwanda, but later tests gave both the all-clear.
(WHO, Rwanda MoH, Science, Health Policy Watch, Reuters, Reuters, T Online, Independent)
Murkier and murkier. Yet another story that we originally thought would be in today's synopsis but made it here thanks to a late-breaking update yesterday. It is bird flu time once again and we're still talking mostly about the US. Mainly because human cases are increasingly being reported from the country and also because health authorities are being extremely cagey with data. Every week, it seems there is a new update related to the mystery case of a human bird flu infection in Missouri. This week's update is that four more healthcare workers in contact with the patient showed flu symptoms. More worryingly, though, health officials in California yesterday announced that two people in contact with animals have tested positive for bird flu. With seemingly no option left, US farmers are now reported to be asking for a vaccination strategy to counter bird flu. Elsewhere around the world, Germany has reported a new bird flu outbreak (in birds) on a farm. And distressingly, reports from Vietnam say 27 tigers and three lions in captivity died from bird flu, contracted from eating sick chicken.
(US CDC, AP, Reuters, Reuters, CBS)
Mpox is still around. And finally, the first story of this week that always belonged in this section: mpox. Mpox cases are rising in Africa, with 68% lacking epidemiological links, underscoring serious gaps in surveillance, contact tracing, and testing infrastructure. The Africa CDC reports that less than 4% of cases have had contacts traced, and only 49.5% of suspected cases are tested, leading to potential under-reporting and uncontrolled virus spread. This outbreak, as Devex reports, continues to highlight the need for research and rapid testing tools, especially for Clade 1, which has been largely overlooked by international health priorities despite its severe impact on Africa. Meanwhile, the WHO has authorised Abbott's Alinity m MPXV assay, a real-time PCR test, for emergency use, marking the first approved mpox diagnostic under the Emergency Use Listing (EUL) to improve testing in outbreak regions. The test detects mpox virus DNA from skin lesion swabs and is intended for trained lab personnel. WHO is still reviewing additional diagnostic tests and collaborating with manufacturers to increase diagnostic options, especially for low-income areas.
(Devex, WHO)
Breakthroughs
Plant power. Researchers have discovered a new semi-synthetic compound, inspired by a natural plant alkaloid, that shows promising activity against the tuberculosis (TB) bacterium, including drug-resistant strains, while sparing other bacteria. The compound, BPD-9, works on multiple Mycobacterium species, including TB, and even targets dormant forms that usually resist treatment. This breakthrough could pave the way for a more targeted, less harmful approach to fighting TB and similar lung infections.
(Microbiology Spectrum)
Bottom line
Climate or commitment? TB remains a global health crisis, and WHO targets for reducing infections and deaths by 2030 face mounting challenges, especially with climate changeincreasing crowded displacement settings where TB spreads more easily. Despite slight progress, the world lags behind 2025 goals, as worsening climate events disrupt healthcare access, making conditions ripe for TB transmission. Addressing TB now demands urgent, coordinated action that considers the intertwined impacts of climate on public health, poverty, and HIV, all while developing disaster-proof TB control strategies. So, we guess that means we aren't eliminating TB.
(Bhekisisa)
Long reads
Big plans meet the real world. Health Policy Watch has an interesting read about the challenges facing the WHO's mRNA tech transfer hub in South Africa. The mRNA hub was launched to empower lower-income countries in vaccine production, yet it faces hurdles that could restrict it to a limited, tech-focused role without fully transferring production expertise.
(Health Policy Watch)
Herd immunity? Wanna buy a bridge? Ever since the first days of Covid, there have been snake oil salesmen around the world trying to sell you on the concept of herd immunity. Here is a studythat says why those people are either misguided or lying. Because when it comes to Covid, we neither have strong antibodies nor is this a virus that won't stop mutating.
(The Journal of Infectious Diseases)
Oh, and Gopal Nair doesn't want you to see this.