August 2022

Britain is launching a polio vaccine booster campaign for children in London aged below 10, after confirming that the virus is spreading in the capital for the first time since the 1980s. 

The UK Health Security Agency has identified 116 polioviruses from 19 sewage samples this year in London. It first raised the alert on finding the virus in sewage samples in June.  

The levels of poliovirus found since and the genetic diversity indicated that transmission was taking place in a number of London boroughs, the agency said on Wednesday. 

No cases have yet been identified but, in a bid to get ahead of a potential outbreak, GPs will now invite children aged 1-9 for booster vaccines, alongside a wider catch-up campaign already announced. Immunization rates across London vary, but are on average below the 95% coverage rate the World Health Organization suggests is needed to keep polio under control. 

Polio, spread mainly through contamination by faecal matter, used to kill and paralyse thousands of children annually worldwide. There is no cure, but vaccination brought the world close to ending the wild, or naturally occurring, form of the disease. It paralyses less than 1% of children who are infected. 

The virus found in London sewage is mainly the vaccine-like virus, which is found when children vaccinated with a particular kind of live vaccine — now only used overseas — shed the virus in their feces. This harmless virus can transmit between unvaccinated children, and while doing so, can mutate back into a more dangerous version of the virus, and cause illness. 

Last month, the United States found a case of paralytic polio outside New York in an unvaccinated individual, its first for a decade. The UKHSA said the case was genetically linked to the virus seen in London.  

Britain is also expanding surveillance for polio to other sites outside London to see if the virus has spread further. The risk to the wider population is assessed as low because most people are vaccinated even if rates are below the optimal levels to prevent spread. 
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Australian health officials say there are encouraging signs that a wave of COVID-19 omicron variant infections is in decline. However, more than 4,000 Australians are hospitalized with the virus and an unknown number of others are suffering the effects of long COVID.

COVID-19 no longer makes the headlines as it once did in Australia. Strict public health measures, including lockdowns, curfews, mask mandates and international border closures that were imposed during the pandemic have come to an end.

The country is doing its best to live with the virus.

More than 95% of Australians older than 16 have received two doses of a coronavirus vaccination, according to government data. More than 70% of the eligible population — 14 million  have had three or more doses.

But the virus persists. Officials have said omicron variants have fueled a recent wave of infections that has coincided with winter in the southern hemisphere. It appears to be weakening. Still, dozens of deaths and thousands of infections are being reported every day.

Leading epidemiologists at the Burnet Institute, a Melbourne-based medical facility, have released new research showing how many lives could be saved if more Australians wore masks.

The institute’s chief executive Brendan Crabb said face coverings continue to be an important defense against the disease.

“We have to change from a high COVID strategy to a low COVID one. We have done modeling with mask use and increasing mask use to say that if that happened even from July that many cases, up to 20% of cases, 20% of hospitalizations, and 14 percent of deaths between July and October could be averted,” said Crabb.

Australia had some of the world’s toughest disease-control measures. Most foreign nationals were banned from Australia for more than two years after March 2020. Australian citizens needed government permission to leave the country. The military was deployed to enforce lockdowns and vaccine mandates were imposed on some key workers.

The country’s coronavirus strategy now relies on individuals making their own decisions about vaccines, masks, hygiene and distancing. However, experts say that the return of personal freedoms has come at a cost.

Australia has recorded 12,400 deaths from coronavirus since the start of the pandemic. More than half of the fatalities occurred in 2022 when restrictions were scrapped.

Government data Wednesday has shown that 9.6 million COVID-19 cases have been diagnosed in Australia during the pandemic. 270,000 active cases are reported across the country.
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U.S. health officials on Tuesday authorized a plan to stretch the nation’s limited supply of monkeypox vaccine by giving people just one-fifth the usual dose, citing research suggesting the reduced amount is about as effective. 

The so-called dose-sparing approach also calls for administering the Jynneos vaccine with an injection just under the skin rather than into deeper tissue — a practice that may rev up the immune system better. Recipients would still get two shots spaced four weeks apart. 

The unusual step is a stark acknowledgment that the U.S. currently lacks the supplies needed to vaccinate everyone seeking protection from the rapidly spreading virus. 

That includes 1.6 million to 1.7 million Americans considered by federal officials to be at highest risk from the disease, primarily men with HIV or men who have a higher risk of contracting it. Vaccinating that group would require more than 3.2 million shots. 

White House officials said the new policy would immediately multiply the 440,000 currently available full doses into more than 2 million smaller doses. 

“It’s safe, it’s effective, and it will significantly scale the volume of vaccine doses available for communities across the country,” Robert Fenton, the White House’s monkeypox response coordinator, told reporters. 

The Biden administration declared monkeypox a public health emergency last week in an effort to slow the outbreak that has infected more than 8,900 Americans. 

The FDA authorized the approach for adults 18 and older who are at high risk of monkeypox infection. Younger people can also get the vaccine if they are deemed high risk, though they should receive the traditional injection, the agency said. 

FDA officials stressed that the second dose is critical to ensuring protection. 

“We feel pretty strongly that the two doses are necessary because, in part, we don’t have any evidence that three, six, eight months later people will be adequately protected by a single dose,” said Dr. Peter Marks, the FDA’s vaccine chief. 

Regulators pointed to a 2015 study showing that inoculation with one-fifth of the traditional two-dose vaccine generated a robust immune-system response comparable to that of the full dose. About 94% of people receiving the smaller dose had adequate levels of virus-fighting antibodies, compared with 98% of those receiving the full dose, according to the study funded by the National Institutes of Health. 

The NIH is planning an additional trial of the technique. And Centers for Disease Control and Prevention Director Dr. Rochelle Walensky said her agency is starting to track real-world vaccine effectiveness in U.S. communities. 

But some experts and advocates worried that with little data to support the policy, it could backfire if it reduces vaccine effectiveness. 

“We have grave concerns about the limited amount of research that has been done on this dose and administration method, and we fear it will give people a false sense of confidence that they are protected,” said David Harvey of the National Coalition of STD Directors in a statement. 

The smaller doses require a different type of injection that penetrates only the top layer of skin, rather than the lower layer between the skin and muscle. That’s a less common technique that may require extra training for some health practitioners.  

“Intradermal administration is certainly something that has been used for other vaccines, including the smallpox vaccine, which was administered to hundreds of millions of people during the 20th century,” said Anne Rimoin, director of UCLA’s Center for Global and Immigrant Health. 

The shallower injection is thought to help stimulate the immune system because the skin contains numerous immunity cells that target outside invaders. 

Rationing vaccine doses is common in Africa and other parts of the world with limited health resources. In recent years the World Health Organization has endorsed the strategy to address outbreaks of yellow fever, polio and other diseases. 

Both the U.K. and Canada have adopted a single-dose vaccine strategy prioritizing people who face the highest risk from monkeypox. And health departments in several large U.S. cities adopted a similar strategy amid limited supplies, including New York, San Francisco and Washington. 

Officials said Tuesday that anyone who previously received a full first dose can get the smaller amount for their second dose. 

U.S. officials have shipped more than 625,000 full vaccine doses to state and local health departments.  

The Biden administration has come under fire for not quickly marshaling millions more doses from the strategic national stockpile.  

The FDA approved the Jynneos vaccine in 2019 to prevent smallpox and monkeypox based, in part, on studies in monkeys.  

Additional human studies showed people who received Jynneos had an immune response similar to those who received an older smallpox vaccine. But Jynneos hasn’t been tested in humans with either monkeypox or its relative smallpox, which was eradicated decades ago. 

 
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The World Meteorological Organization or WMO reports the month of July was one of the three warmest on record globally. This, despite a weak La Nina event, which is supposed to have a cooling influence.

Meteorologists warn the heatwave that swept through large parts of Europe last month is set to continue in August. They note July was drier than average in much of Europe, badly affecting local economies and agriculture, as well as increasing the risk of wildfires.

WMO Spokeswoman Clare Nullis says Britain’s Met Office has issued another advisory warning of a heat buildup throughout this week. However, she says temperatures are not expected to reach the extreme, record-setting temperatures of more than 40 degrees Celsius seen in July.

“But it is well above average. Temperatures in France this week, well above average. In Switzerland, many parts of Switzerland well above average. And as I said, continuing the trend that we saw in July, Spain saw its hottest ever month in July. So, not just the hottest July but the hottest ever month on record.”

Nullis says Europe and other parts of the world will have to get used to and adapt to the kind of heatwaves WMO’s Secretary-General Petteri Taalas calls “the new normal.”

While Europe was sweltering under extreme heat in July, WMO reports Antarctic Sea ice reached its lowest July level on record. This follows a record low Sea ice level in June. While Europe saw a lot of heat in July, Nullis notes big chunks of the Antarctic did as well.

“It is important to bear in mind there is quite a big sort of monthly and year-to-year variability in Antarctica. So, the fact that it was the lowest on record in June and in July does not mean necessarily that this is a long-term irreversible trend.”

WMO reports the long-lasting drought in parts of Europe also is set to continue. It warns below-normal precipitation in many parts of Europe will cause or worsen drought conditions and likely trigger more forest fires.
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Five southern African countries, with more than half the continent’s elephants, are conducting a first-ever aerial census to determine the elephant population and how to protect it. 

Light aircraft will fly simultaneously across the plains of Angola, Botswana, Namibia, Zambia and Zimbabwe — in a conservation area known as the Kavango-Zambezi Trans-frontier Conservation Area (KAZA) — in an exercise that will run until October 20.

KAZA is home to an estimated 220,000 elephants, and the five countries are keen to know the exact figures and the animals’ distribution patterns. 

More than 130,000 of the animals are found in Botswana, which has the world’s largest elephant population. 

Botswana’s National Parks and Wildlife director, Kabelo Senyatso, said the population count will be key in the management of the elephants. 

The data primarily will be used to guide decision-making by the five partner states, Senyatso said, including land-use planning, managing human-elephant conflict, hunting, and tourism.

Senyatso said the exercise is critical for a region with a high number of trans-boundary elephants. 

“It is important that as managers of the resource, we have a clear understanding of where they are and how they are distributed across the landscape,” Senyatso said. “It is an exciting project, the first of its kind. We expect the data on the patterns to be analyzed starting early 2023 such that by quarter one of 2023, we would already be having preliminary data that we can share with the public and for our decision-making.”      

KAZA’s executive director, Nyambe Nyambe, said the elephant count will determine a scientific approach to the management of the elephant populations.      

“It is highly anticipated that it will generate science-based information on the population distribution and other factors and is a reaffirmation of the KAZA partner states’ commitment to the joint pursuit of science-led conservation supported by accurate and reliable data,” Nyambe said. “The results from this survey will become the cornerstone for the long-term protection and management of Africa’s largest trans-boundary elephant population.”     

Botswana-based conservationist Map Ives said revealing the elephant migration patterns across the five countries’ borders is key. 

“We hope to see what the results come up with,” Ives said. “What we will be interested in seeing is not only how many elephants there are but the distribution, therefore, and what the likelihood of those elephants moving between countries is. We know that this population is one single contiguous population.”          

While elephant populations are increasing in the KAZA region, elsewhere on the African continent the numbers are decreasing due to loss of habitat and poaching. 

 
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A new philanthropic project hopes to invest $100 million in 10 countries, mostly in Africa, by 2030 to support 200,000 community health workers, who serve as a critical bridge to treatment for people with limited access to medical care.

The Skoll Foundation and The Johnson & Johnson Foundation announced Monday that they donated a total of $25 million to the initiative. The Global Fund to Fight AIDS, TB and Malaria, which will oversee the project, matched the donations and hopes to raise an additional $50 million.

The investment seeks to empower the front-line workers that experts say are essential to battling outbreaks of COVID-19, Ebola and HIV.

“What have we found out in terms of community health workers?” said Francisca Mutapi, a professor at the University of Edinburgh, who helps lead a multiyear project to treat neglected tropical diseases in multiple African countries. “They are very popular. They are very effective. They are very cost effective.”

On a recent trip to Zimbabwe for research, Mutapi described how a community health worker negotiated the treatment of a parasitic infection in a young child who was part of a religious group that doesn’t accept clinical medicine.

“She’s going to the river, getting on with her day-to-day business, and she notices that one of the children in her community is complaining about a stomachache,” said Mutapi.

The woman approached the child’s grandmother for permission to bring the child to a clinic, which diagnosed and began treating the child for bilharzia. That would not have happened without the woman’s intervention, Mutapi said.

Ashley Fox, an associate professor specializing in global health policy at Albany, SUNY, said evidence shows community health workers can effectively deliver low-cost care “when they are properly equipped and trained and paid – that’s a big caveat.”

Though the current number of these workers is not well documented, in 2017, the Africa Centers for Disease Control and Prevention estimated that the continent required 2 million to meet health targets. Many of these workers are women and unpaid, though The Global Fund advocates for some sort of salary for them.

“It’s hard to think of a better set of people that you would want to be paying if you think about it from both the point of view of creating good jobs as well as maximizing the health impact,” said Peter Sands, the fund’s executive director.

The Global Fund, founded in 2002, channels international financing with the aim of eradicating treatable infectious diseases. In addition to its regular three-year grants to countries, it will deploy these new philanthropic donations through a catalytic fund to encourage spending on some of the best practices and program designs.

Last Mile Health, part of the Africa Frontline First health initiative, has worked with the Liberian government to expand and strengthen its community health program since 2016.

In the early months of the COVID-19 pandemic, former Liberian president and Noble Peace Prize recipient, Ellen Johnson Sirleaf, convened Last Mile Health and other organizations to grapple with a response.

“We were all kind of seeing the Deja vu moment of recalling back to a couple of years ago where Liberia was beset by this tragic epidemic of Ebola,” said Nan Chen, managing director of Last Mile Health. “And as President Sirleaf reminded us: the tide was turned when we turned to the community.”

Along with the other organizations that specialize in the financing, research and policy of public health, they set about designing an initiative to expand community health programs and to capitalize on the attention the pandemic brought to the need for disease surveillance.

The catalytic fund is the result. “I think the pandemic has shone a light on the critical role of these health workers,” said Lauren Moore, vice president of global community impact at Johnson & Johnson.

Don Gips, CEO of the Skoll Foundation, emphasized that these workers also can raise early warnings that benefit people everywhere.

“It’s critical not just for delivering health care in Africa, but this is how we’ll also catch the next set of diseases that could threaten populations around the world,” said Gips, who is also the former U.S. ambassador to South Africa. 

Last Mile Health won a major donation from the Skoll Foundation in 2017 and has also received large donations from the Audacious Project from TED and Co-Impact, another funding collective. The organization’s co-founder, Raj Panjabi, now serves in the Biden administration.

“What philanthropy has noticed about Last Mile Health is that we were not only taking direct action on the problem by actively managing community health worker programs, but that we were seeing our innovation adopted in national policy at scale,” said James Nardella, the organization’s chief program officer.

SUNY’s Fox and other experts say linking the work of community health care workers to the national health system is a priority, along with securing sustainable funding for their programs.

The Global Fund said it will assist countries with the design of proposed community health care worker expansions over the next year.

Chen acknowledged there is no silver bullet for the issue of sustainability.

“Part of the work that organizations like Last Mile Health have to do is to sit in that discomfort and wrestle with it, with our partners, with donors, until we incrementally squeeze out the solution here,” Chen said.

Mutapi said eventually governments must fund the programs themselves and she argued the experiences of places like Zimbabwe and Liberia with community health workers could benefit people in other contexts as well.

“Actually, having lived on Scottish islands, which are inaccessible,” she said, the innovation of community health workers is “something that actually can be exported to Western communities that are remote because that connection between a health provider and the local community is really important for compliance and for access.” 
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