This Week in Global Health: Dengue in Peru, Vaccine Equity and More
Latest developments in global health policy, politics and practice — every week is a chance to save lives
The headline you might have missed
New study finds that millions of lives could have been saved if Covid vaccines had been distributed more fairly, even without faster or more supply
Nature, Estimating the impact of COVID-19 vaccine inequities: a modeling study
This should have been in every major news outlet. Covid vaccination has saved millions of lives and could have saved more if there was fair access to them globally.
Outbreaks
Dengue is hitting Peru hard and confirming the wisdom of dengue experts, who told me a decade ago, “Dengue has resulted in the resignation of more health ministers than any other disease.” Why? Because most of the things we do for it don’t work. The mosquito that spreads it, Aedes aegypti, is the cockroach of mosquitoes. Fogging, reduction of standing water and other measures are highly visible but minimally effective, especially once an outbreak is well underway. We were able to stop another disease spread by Aedes aegypti, Zika, in Miami through targeted aerial spraying of ultralow-volume pesticides along with aerial administration of natural larvicides. Controversial, expensive, and not easy to succeed. Spread of dengue and cholera, among other diseases, are yet more manifestations of the health risks of climate change.
Some good news
The Mpox vaccine works very well, even if given AFTER exposure! Now, to provide the financial, material, and technical support for our colleagues in Africa to stop spread there. Rebounding childhood vaccination programs globally supported by Gavi and others show that this can succeed.
Also, WHO has certified Belize malaria-free. The country reduced its malaria burden dramatically from a 1994 peak of ~10,000 cases to zero indigenous cases in 2019 in a 70-year push emphasizing strong surveillance, improving access to diagnosis, and vector control.
Around the world
Lots of meetings, not lots of progress on a new pandemic treaty or on revisions to the International Health Regulations. Mexico and Norway are facilitating more discussion to narrow areas of disagreement, especially around sharing of vaccines and other countermeasures and technology transfer to lower-income countries. This in the context of a clear need for more partnerships and more funding as countries cut health care and health security budgets, as outlined in a World Bank paper.
WHO, African Development Bank (AfDB), European Investment Bank (EIB), and the Islamic Development Bank (IsDB) announced the launch of the Health Impact Investment Platform (HIIP) with an initial €1.5B available to low- and middle-income countries in concessional loans and grants to expand the reach and scope of primary health care. The Inter-American Development Bank (IDB) is considering joining this partnership, which would extend this initiative to Latin America and the Caribbean. WHO will be the platform’s policy coordinator, promoting alignment of financing decisions with national health priorities and strategies.
Let’s hope they can be strategic, addressing governance and financing to move from 45 years of well-intentioned commitments to actual progress bringing epidemic-ready primary health care to people.
In the United States
Doctors, patients, insurers and others will grapple with changing formulations of and recommendations for Covid vaccines — appropriately being updated as the virus evolves and our immunity waxes and wanes.
Dr. Mandy Cohen will be the next CDC director, bringing deep experience at the national and state levels and a strong management background. She will have to deal with a hostile Congress, a budget that cut hundreds of millions of dollars from domestic and global health protection programs, and staff who have been through difficult years.
Important new science
ChatGPT 4.0 is getting pretty darn good at diagnosing patients! Dr. Eric Topol did an excellent review of this article and of the broader issues. AI isn’t just another bright shiny object — it’s useful. Now the challenge is to make it work for patients, clinicians, and health care systems.
Bavarian Nordic reported promising clinical trial findings for its chikungunya vaccine in people age 65 and older. Immunogenicity after a single dose exceeded the threshold established for by regulatory authorities. The company is awaiting results for a larger trial. An effective vaccine would be a major benefit, although because it’s a live attenuated vaccine, might not be available for some people, such as those who are immunosuppressed.
What to look for in the coming days
Additional controversy over PEPFAR funding the United States.
PEPFAR has been an astoundingly successful program, saving more than 25 million lives, transforming communities, and strengthening health systems. It’s the only truly whole-of-government approach I’ve ever seen work. A group of elected officials and advocates are pushing for all organizations which in any way support abortion — even if not with PEPFAR funds — to be excluded from the program in the future. PEPFAR is one of the greatest success stories in the history of global health — it’s crucial that it be preserved.
With research support from Marine Buissonniere
